Provider Demographics
NPI:1356908974
Name:WATSON, MARKEVIS (PTA)
Entity type:Individual
Prefix:
First Name:MARKEVIS
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 E BASIN RD APT E6
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4246
Mailing Address - Country:US
Mailing Address - Phone:302-494-6514
Mailing Address - Fax:
Practice Address - Street 1:3300 CONCORD PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-5028
Practice Address - Country:US
Practice Address - Phone:302-753-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
DEJ2-0001211225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant