Provider Demographics
NPI:1669655155
Name:WATSON CLINIC LLP
Entity Type:Organization
Organization Name:WATSON CLINIC LLP
Other - Org Name:WATSON CLINIC LLP CENTER FOR REHABILITATIVE MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSBRUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-680-7007
Mailing Address - Street 1:1430 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3202
Mailing Address - Country:US
Mailing Address - Phone:863-680-7700
Mailing Address - Fax:
Practice Address - Street 1:1430 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3202
Practice Address - Country:US
Practice Address - Phone:863-680-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880988700Medicaid
FLG25OtherBCBS
FL880988700Medicaid