Provider Demographics
NPI:1114557147
Name:WATSON, JOSHUA DRAGE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DRAGE
Last Name:WATSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26741 PORTOLA PKWY STE 1E-630
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1743
Mailing Address - Country:US
Mailing Address - Phone:409-771-9642
Mailing Address - Fax:949-597-2061
Practice Address - Street 1:30230 RANCHO VIEJO RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1569
Practice Address - Country:US
Practice Address - Phone:949-461-1250
Practice Address - Fax:949-429-5999
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist