Basic Information
| Provider Information | |||||||||
| NPI: | 1275703282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | BRUCE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 STANTON AVE | ||||||||
| Address2: | |||||||||
| City: | AUBURNDALE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024663005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8574046432 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12020 PACIFIC ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681543507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002599897 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2008 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 7686 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.