Individual
MR. KENNETH LEE WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-3133
(215) 707-3945
Mailing address
15032 POQUESSING CREEK LN, PHILADELPHIA, PA 19116-1531
(267) 446-6521
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
TEI002569
PA
363A00000X
Physician Assistant
25MP00409400
NJ
363AM0700X
Medical Physician Assistant
Primary
MA060559
PA
Other
Enumeration date
03/30/2010
Last updated
03/14/2022
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