Provider Demographics
NPI:1417515131
Name:WATKINS, EMILY A (PT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:WATKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 LANE 120
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:IN
Mailing Address - Zip Code:46742
Mailing Address - Country:US
Mailing Address - Phone:260-667-7088
Mailing Address - Fax:
Practice Address - Street 1:500 E HARCOURT RD
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-7590
Practice Address - Country:US
Practice Address - Phone:260-665-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99093089A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN99093089AOtherLICENSE