Provider Demographics
NPI:1780753178
Name:WATSON, ANGELA J (PT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:J
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 S OAKDALE DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:IN
Mailing Address - Zip Code:47243-9703
Mailing Address - Country:US
Mailing Address - Phone:812-866-5434
Mailing Address - Fax:812-866-5434
Practice Address - Street 1:90 S OAKDALE DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:IN
Practice Address - Zip Code:47243-9703
Practice Address - Country:US
Practice Address - Phone:812-866-5434
Practice Address - Fax:812-866-5434
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004647A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics