Provider Demographics
NPI:1255563573
Name:WATSON, JOHN JR (DPT)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:WATSON
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRODNAX
Mailing Address - State:VA
Mailing Address - Zip Code:23920-2745
Mailing Address - Country:US
Mailing Address - Phone:252-529-5171
Mailing Address - Fax:
Practice Address - Street 1:1755 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:VA
Practice Address - Zip Code:23950
Practice Address - Country:US
Practice Address - Phone:434-447-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12111225100000X
VA2305206870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist