Provider Demographics
NPI:1750492583
Name:WATT, FREDDIE BRIDGES (LD)
Entity Type:Individual
Prefix:MRS
First Name:FREDDIE
Middle Name:BRIDGES
Last Name:WATT
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12706 RIVA RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-3242
Mailing Address - Country:US
Mailing Address - Phone:713-726-0618
Mailing Address - Fax:713-726-0618
Practice Address - Street 1:12706 RIVA RIDGE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-3242
Practice Address - Country:US
Practice Address - Phone:713-726-0618
Practice Address - Fax:713-726-0618
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT01276133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist