Provider Demographics
NPI:1477946689
Name:WATTS, JEFFREY MARTIN (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MARTIN
Last Name:WATTS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1569
Mailing Address - Country:US
Mailing Address - Phone:803-329-4685
Mailing Address - Fax:
Practice Address - Street 1:1075 BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1569
Practice Address - Country:US
Practice Address - Phone:803-329-4685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3002174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist