Basic Information
| Provider Information | |||||||||
| NPI: | 1386203826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | TAYLIN | ||||||||
| MiddleName: | EVETTE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1416 WREYHILL DR | ||||||||
| Address2: | |||||||||
| City: | HURST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760533840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143641686 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 MEDICAL PKWY | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786667520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123961888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2019 | ||||||||
| LastUpdateDate: | 06/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1317710 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.