Basic Information
| Provider Information | |||||||||
| NPI: | 1003149063 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 HILL COUNTRY TRL | ||||||||
| Address2: | |||||||||
| City: | WIMBERLEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786769362 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 RANCH ROAD 3237 | ||||||||
| Address2: | |||||||||
| City: | WIMBERLEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786765311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128475540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2009 | ||||||||
| LastUpdateDate: | 09/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1161909 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.