Provider Demographics
NPI:1205132701
Name:WATTS, BRIAN ALLAN (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALLAN
Last Name:WATTS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3121 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3473
Mailing Address - Country:US
Mailing Address - Phone:979-776-0169
Mailing Address - Fax:979-776-1372
Practice Address - Street 1:3121 UNIVERSITY DR E
Practice Address - Street 2:SUITE 100
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3473
Practice Address - Country:US
Practice Address - Phone:979-776-0169
Practice Address - Fax:979-776-1372
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4699208100000X
TX1236349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation