Provider Demographics
NPI:1801505003
Name:WATTS, BRADLEY J
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:WATTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25917 ALLENS GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IA
Mailing Address - Zip Code:52745-9641
Mailing Address - Country:US
Mailing Address - Phone:563-940-1599
Mailing Address - Fax:
Practice Address - Street 1:30 N GOULD ST STE R
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6317
Practice Address - Country:US
Practice Address - Phone:563-940-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health