Provider Demographics
NPI:1770679748
Name:WATSON, KIMBERLY DAWN (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:1601 UNION AVE
Practice Address - Street 2:SUITE D
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065
Practice Address - Country:US
Practice Address - Phone:724-224-5090
Practice Address - Fax:724-224-5093
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003889L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3818118OtherAETNA
PAKO500701OtherHIGHMARK BLUE SHIELD
PA134933OtherHEALTH AMER/HEALTH ASSUR.
PA396749Medicare ID - Type UnspecifiedMEDICARE