Provider Demographics
NPI:1073673646
Name:WATSON, MELANIE M (PT, MPT)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N JACKSON RD STE 900
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501
Mailing Address - Country:US
Mailing Address - Phone:956-661-0475
Mailing Address - Fax:956-621-7518
Practice Address - Street 1:1201 N JACKSON RD STE 900
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-661-0475
Practice Address - Fax:956-621-7518
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1163170174400000X, 2251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143404501Medicaid
TX143404501Medicaid
TX143404501Medicaid