Provider Demographics
NPI:1356655351
Name:WATSON, KATY JO (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:JO
Last Name:WATSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2113 GOLF COURSE RD SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1656
Mailing Address - Country:US
Mailing Address - Phone:505-898-9700
Mailing Address - Fax:505-898-8539
Practice Address - Street 1:2113 GOLF COURSE RD SE
Practice Address - Street 2:SUITE 106
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1656
Practice Address - Country:US
Practice Address - Phone:505-898-9700
Practice Address - Fax:505-898-8539
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM3953225100000X
TX1197976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist