Individual
JESSICA ANN WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
120 N TOWER RD, CARBONDALE, IL 62901-1929
(618) 549-3355
Mailing address
2355 DR SPRINGS RD, CARTERVILLE, IL 62918-3115
(618) 967-1589
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160008096
IL
Other
Enumeration date
10/05/2020
Last updated
10/05/2020
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