Provider Demographics
NPI:1164674693
Name:WATSON, ALISHA NICOLE (PTA)
Entity Type:Individual
Prefix:MS
First Name:ALISHA
Middle Name:NICOLE
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 1:1960 N 79TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2049
Mailing Address - Country:US
Mailing Address - Phone:913-530-4175
Mailing Address - Fax:
Practice Address - Street 1:3301 W PARK ROW BLVD
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4846
Practice Address - Country:US
Practice Address - Phone:903-872-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2068447225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant