Provider Demographics
NPI:1699100545
Name:WATTS, KOLBY ALLEN (PT)
Entity type:Individual
Prefix:MR
First Name:KOLBY
Middle Name:ALLEN
Last Name:WATTS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHWAY 15 S STE 136
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-8636
Mailing Address - Country:US
Mailing Address - Phone:606-693-9644
Mailing Address - Fax:606-693-9643
Practice Address - Street 1:100 HIGHWAY 15 S STE 136
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-8636
Practice Address - Country:US
Practice Address - Phone:606-693-9644
Practice Address - Fax:606-693-9643
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist