Provider Demographics
NPI:1821100348
Name:WATASE, VALERIE J (PT)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:J
Last Name:WATASE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3468 MT DIABLO BLVD
Mailing Address - Street 2:SUITE B110
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-7105
Mailing Address - Country:US
Mailing Address - Phone:925-284-6150
Mailing Address - Fax:925-284-6155
Practice Address - Street 1:3468 MT DIABLO BLVD
Practice Address - Street 2:SUITE B110
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-7105
Practice Address - Country:US
Practice Address - Phone:925-284-6150
Practice Address - Fax:925-284-6155
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17431ZMedicare PIN