Provider Demographics
NPI:1437732120
Name:WATSON SPORTS PERFORMANCE & REHABILITATION INC
Entity Type:Organization
Organization Name:WATSON SPORTS PERFORMANCE & REHABILITATION INC
Other - Org Name:WATSON SPORTS PERFORMANCE & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE/ OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-481-9113
Mailing Address - Street 1:1000 CALLE AMANECER
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6214
Mailing Address - Country:US
Mailing Address - Phone:949-481-9113
Mailing Address - Fax:949-481-9124
Practice Address - Street 1:1000 CALLE AMANECER
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6214
Practice Address - Country:US
Practice Address - Phone:949-481-9113
Practice Address - Fax:949-481-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty