Provider Demographics
NPI:1376955252
Name:WATKINS, THOMAS IV (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:WATKINS
Suffix:IV
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4119
Mailing Address - Country:US
Mailing Address - Phone:804-747-7472
Mailing Address - Fax:804-747-7441
Practice Address - Street 1:3920 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4119
Practice Address - Country:US
Practice Address - Phone:804-747-7472
Practice Address - Fax:804-747-7441
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist