Provider Demographics
NPI:1134703267
Name:WATSON, AMY TERESA (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:TERESA
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7443 YORKSHIRE BLVD N
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-4232
Mailing Address - Country:US
Mailing Address - Phone:317-670-3192
Mailing Address - Fax:
Practice Address - Street 1:4055 ROY WILSON WAY
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-8032
Practice Address - Country:US
Practice Address - Phone:317-866-7472
Practice Address - Fax:317-620-2865
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004168A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist