Individual
KEVIN MARK WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC/L
Contact information
Practice address
11130 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1735
(260) 901-3261
Mailing address
1406 VILLA CT, NORTH MANCHESTER, IN 46962-1344
(260) 901-3261
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
36000424A
IN
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
03/08/2006
Last updated
03/14/2016
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