Provider Demographics
NPI:1659558724
Name:WATSON, BRIAN AVERY (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:AVERY
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 1:6011 UNIVERSITY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6104
Mailing Address - Country:US
Mailing Address - Phone:410-203-0391
Mailing Address - Fax:410-203-2707
Practice Address - Street 1:6011 UNIVERSITY BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6104
Practice Address - Country:US
Practice Address - Phone:410-203-0391
Practice Address - Fax:410-203-2707
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist