Individual
JESSICA SHANNON WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
404 NW HALL OF FAME DR, LAKE CITY, FL 32055-4833
(386) 755-3163
(386) 755-3165
Mailing address
463 SW MULESKINNER CT, LAKE CITY, FL 32024-1133
(352) 339-0872
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA22089
FL
Other
Enumeration date
08/07/2012
Last updated
08/07/2012
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