Provider Demographics
NPI:1801623897
Name:WATTS, KENSLEY ALISE (PTA)
Entity type:Individual
Prefix:MRS
First Name:KENSLEY
Middle Name:ALISE
Last Name:WATTS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 HILDRETH POOL RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-6534
Mailing Address - Country:US
Mailing Address - Phone:940-366-1999
Mailing Address - Fax:
Practice Address - Street 1:4144 HILDRETH POOL RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-6534
Practice Address - Country:US
Practice Address - Phone:940-366-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2185241225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant