1326471343 NPI number — MRS. CHRISTINA MARY WATSON P.T.

Table of content: MRS. CHRISTINA MARY WATSON P.T. (NPI 1326471343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326471343 NPI number — MRS. CHRISTINA MARY WATSON P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATSON
Provider First Name:
CHRISTINA
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATSON
Provider Other First Name:
CHRISTIE
Provider Other Middle Name:
CUPITT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1326471343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 LAKE BOONE TRL
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607-7511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-781-4434
Provider Business Mailing Address Fax Number:
919-781-5851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 LAKE BOONE TRL
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-7511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-781-4434
Provider Business Practice Location Address Fax Number:
919-781-5851
Provider Enumeration Date:
08/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  9440 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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