Individual
RICKY LEE WATTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4141 LAKELAND HILLS BLVD, LAKELAND, FL 33805-1978
(863) 937-8070
Mailing address
6517 HEREFORD DR, LAKELAND, FL 33810-6215
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA014262
FL
Other
Enumeration date
07/20/2010
Last updated
07/20/2010
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