Provider Demographics
NPI:1194021840
Name:WATT, DJUNA CATHERINE (PT)
Entity Type:Individual
Prefix:MS
First Name:DJUNA
Middle Name:CATHERINE
Last Name:WATT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DJUNA
Other - Middle Name:WATT
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3419 VIA LIDO # 332
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3908
Mailing Address - Country:US
Mailing Address - Phone:949-675-2639
Mailing Address - Fax:
Practice Address - Street 1:3441 VIA LIDO STE C
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4788
Practice Address - Country:US
Practice Address - Phone:949-675-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist