Provider Demographics
NPI:1952579823
Name:WATSON, MARION AUBREY (PT)
Entity Type:Individual
Prefix:MR
First Name:MARION
Middle Name:AUBREY
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 1:2071 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1358
Mailing Address - Country:US
Mailing Address - Phone:316-942-5335
Mailing Address - Fax:
Practice Address - Street 1:2071 N WEST ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-1358
Practice Address - Country:US
Practice Address - Phone:316-942-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS141281OtherBC/BS
KS141281OtherBC/BS