Provider Demographics
NPI:1528140340
Name:WATSON, DENISE E (MS, PT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:E
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8796 ROUTE 219
Mailing Address - Street 2:
Mailing Address - City:BROCKWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15824-6010
Mailing Address - Country:US
Mailing Address - Phone:814-265-2197
Mailing Address - Fax:
Practice Address - Street 1:411 W MAHONING ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1907
Practice Address - Country:US
Practice Address - Phone:814-265-2197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001234E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA134933OtherHEALTH AMER/HEALTH ASSUR.
PAWA438904OtherHIGHMARK BLUE SHIELD
PA396749Medicare ID - Type UnspecifiedMEDICARE
PA7609688OtherAETNA