Provider Demographics
NPI:1467882126
Name:WATTS, MANDY LYNN (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:LYNN
Last Name:WATTS
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 EASTGATE MALL STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1979
Mailing Address - Country:US
Mailing Address - Phone:185-877-5926
Mailing Address - Fax:850-398-8482
Practice Address - Street 1:88 E BONITA RD STE C
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3057
Practice Address - Country:US
Practice Address - Phone:619-230-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-17
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT320132251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic