Basic Information
| Provider Information | |||||||||
| NPI: | 1972062362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | LYNELLE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT, MFDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3290 NE 65TH ST | ||||||||
| Address2: | UNIT 101 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063882549 | ||||||||
| FaxNumber: | 2068294352 | ||||||||
| Practice Location | |||||||||
| Address1: | 3290 NE 65TH STREET | ||||||||
| Address2: | UNIT 101 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063882549 | ||||||||
| FaxNumber: | 2068294352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2019 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60921817 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.