Basic Information
| Provider Information | |||||||||
| NPI: | 1275667081 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | MAY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 N MARINE DR APT 19G | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606132328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739350984 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6705 KINGERY HWY | ||||||||
| Address2: | |||||||||
| City: | WILLOWBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605275142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303886700 | ||||||||
| FaxNumber: | 6303886777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.