1972062362 NPI number — DR. LYNELLE MARIE WATSON PT, DPT, MFDC

Table of content: (NPI 1659524221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972062362 NPI number — DR. LYNELLE MARIE WATSON PT, DPT, MFDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATSON
Provider First Name:
LYNELLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, MFDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972062362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3290 NE 65TH ST
Provider Second Line Business Mailing Address:
UNIT 101
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-388-2549
Provider Business Mailing Address Fax Number:
206-829-4352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3290 NE 65TH STREET
Provider Second Line Business Practice Location Address:
UNIT 101
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-388-2549
Provider Business Practice Location Address Fax Number:
206-829-4352
Provider Enumeration Date:
03/15/2019

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:  PT60921817 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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