Provider Demographics
NPI:1083117394
Name:WATSON, CHRISTINA MARIE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 KENTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6049
Mailing Address - Country:US
Mailing Address - Phone:586-255-2198
Mailing Address - Fax:
Practice Address - Street 1:44800 DELCO BLVD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1026
Practice Address - Country:US
Practice Address - Phone:586-726-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2022-11-01
Deactivation Date:2022-10-26
Deactivation Code:
Reactivation Date:2022-11-01
Provider Licenses
StateLicense IDTaxonomies
MI55010110182251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic