Basic Information
| Provider Information | |||||||||
| NPI: | 1770679748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 430 INNOVATION DRIVE | ||||||||
| Address2: | |||||||||
| City: | BLAIRSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157178096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243434060 | ||||||||
| FaxNumber: | 7243434069 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 UNION AVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | NATRONA HEIGHTS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242245090 | ||||||||
| FaxNumber: | 7242245093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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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 | PT003889L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3818118 | 01 | PA | AETNA | OTHER | KO500701 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 134933 | 01 | PA | HEALTH AMER/HEALTH ASSUR. | OTHER |