Provider Demographics
NPI:1710264858
Name:WATSON, DEBORAH CM (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CM
Last Name:WATSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12755 SW HIGHWAY 484
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-6422
Mailing Address - Country:US
Mailing Address - Phone:352-489-3400
Mailing Address - Fax:
Practice Address - Street 1:12755 SW HIGHWAY 484
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-6422
Practice Address - Country:US
Practice Address - Phone:352-489-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA32385225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist