Provider Demographics
NPI:1356822738
Name:JAMES-WATSON, LISA-ANN
Entity Type:Individual
Prefix:
First Name:LISA-ANN
Middle Name:
Last Name:JAMES-WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6536
Mailing Address - Country:US
Mailing Address - Phone:954-292-0959
Mailing Address - Fax:954-731-3658
Practice Address - Street 1:5901 NW 79TH AVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4639
Practice Address - Country:US
Practice Address - Phone:954-292-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23507225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant