Provider Demographics
NPI:1003215120
Name:WATTS, NATHAN D (DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:D
Last Name:WATTS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8809
Mailing Address - Country:US
Mailing Address - Phone:828-294-9130
Mailing Address - Fax:828-291-9159
Practice Address - Street 1:2165 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8809
Practice Address - Country:US
Practice Address - Phone:828-294-9130
Practice Address - Fax:828-291-9159
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7495225100000X
NCP15118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01386371OtherRAILROAD MEDICARE PROFESSIONAL REHABILITATION SERVICES
SCP01386413OtherMEDICARE RAILROAD PRS 4 LLC
SCP01386568OtherRAILROAD MEDICARE PRS II LLC
SCQ47757E293Medicare PIN
SCQ47757C630Medicare PIN
SCQ47757A382Medicare PIN
SCQ477577906Medicare PIN
SCP01386568OtherRAILROAD MEDICARE PRS II LLC