Provider Demographics
NPI:1710450077
Name:COLLEGE STATION PHYSICAL THERAPY AND PERFORMANCE, PLLC
Entity Type:Organization
Organization Name:COLLEGE STATION PHYSICAL THERAPY AND PERFORMANCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:979-353-2492
Mailing Address - Street 1:3201 UNIVERSITY DR E STE 320
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3478
Mailing Address - Country:US
Mailing Address - Phone:979-353-2492
Mailing Address - Fax:979-776-1372
Practice Address - Street 1:3201 UNIVERSITY DR E STE 320
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3478
Practice Address - Country:US
Practice Address - Phone:979-353-2492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy