Individual
BRIAN M WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
6300 67TH ST, KENOSHA, WI 53142-1437
(262) 484-4724
Mailing address
6300 67TH ST, KENOSHA, WI 53142-1437
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1002-19
WI
Other
Enumeration date
10/05/2011
Last updated
10/05/2011
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