Provider Demographics
NPI:1003062357
Name:WATSON, ELISE KEARNS (PT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:KEARNS
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CREEKROCK CIR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8037
Mailing Address - Country:US
Mailing Address - Phone:859-401-2941
Mailing Address - Fax:480-323-2104
Practice Address - Street 1:107 CREEKROCK CIR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8037
Practice Address - Country:US
Practice Address - Phone:859-401-2941
Practice Address - Fax:480-323-2104
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist