Provider Demographics
NPI:1124374590
Name:WATKINS, ROXANA M (PTA)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:M
Last Name:WATKINS
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 1:315 E COOK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-3311
Mailing Address - Country:US
Mailing Address - Phone:260-489-7334
Mailing Address - Fax:260-489-8413
Practice Address - Street 1:315 E COOK RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-3311
Practice Address - Country:US
Practice Address - Phone:260-489-7334
Practice Address - Fax:260-489-8413
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004333A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant