Provider Demographics
NPI:1487957890
Name:WATSON, TERESA MARIE (MPT)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:WATSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:218-760-0226
Mailing Address - Fax:
Practice Address - Street 1:106 5TH ST S
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484-1123
Practice Address - Country:US
Practice Address - Phone:218-547-1900
Practice Address - Fax:218-547-3913
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist