Provider Demographics
NPI:1588272330
Name:WATKINS, LAURA E (PTA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:WATKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PAVILLION PLACE
Mailing Address - Street 2:
Mailing Address - City:PENNY FARMS
Mailing Address - State:FL
Mailing Address - Zip Code:32079
Mailing Address - Country:US
Mailing Address - Phone:888-531-2204
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:3 PAVILLION PLACE
Practice Address - Street 2:
Practice Address - City:PENNEY FARMS
Practice Address - State:FL
Practice Address - Zip Code:32079
Practice Address - Country:US
Practice Address - Phone:904-297-9763
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22710225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant