Provider Demographics
NPI:1275024077
Name:WATSON, BHREA (PTA)
Entity Type:Individual
Prefix:
First Name:BHREA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BHREA
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 W PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2147
Mailing Address - Country:US
Mailing Address - Phone:501-812-4970
Mailing Address - Fax:
Practice Address - Street 1:505 W PERSHING BLVD STE D
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2157
Practice Address - Country:US
Practice Address - Phone:501-812-4970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4296225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant