Basic Information
| Provider Information | |||||||||
| NPI: | 1609283225 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WATSON | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 CHAMBERS SQ | ||||||||
| Address2: | |||||||||
| City: | VALLEY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368542800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052593991 | ||||||||
| FaxNumber: | 2058768063 | ||||||||
| Practice Location | |||||||||
| Address1: | 1275 HIGHWAY 54 W | ||||||||
| Address2: | STE 200 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704608609 | ||||||||
| FaxNumber: | 7704608629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2014 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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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 | 225100000X | AL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT011809 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.