Provider Demographics
NPI:1992006662
Name:WATSON, WILLIAM CLAYTON (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CLAYTON
Last Name:WATSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 E PANORAMA WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2816
Mailing Address - Country:US
Mailing Address - Phone:801-716-2289
Mailing Address - Fax:
Practice Address - Street 1:2155 E PANORAMA WAY
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-2816
Practice Address - Country:US
Practice Address - Phone:801-673-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4911299-2401225100000X
UT49112992401171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT27-0926842OtherMEDICARE TAX #