Provider Demographics
NPI:1083739569
Name:WATSON, STARR BENSON (PTA)
Entity Type:Individual
Prefix:
First Name:STARR
Middle Name:BENSON
Last Name:WATSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 MERESTONE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-5155
Mailing Address - Country:US
Mailing Address - Phone:910-392-5618
Mailing Address - Fax:910-794-3334
Practice Address - Street 1:2744 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6606
Practice Address - Country:US
Practice Address - Phone:910-794-3319
Practice Address - Fax:910-794-3334
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1818225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant