Individual provider Active NPI

Brian Avery Watson, PT

  • Physical Therapist
  • Ellicott City, MD
National Provider Identifier
1659558724
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
22316 Issued in MD
Practice address
6011 University Blvd Ste 120
Ellicott City, MD 21043-6104
Phone
(410) 203-0391
Fax
(410) 203-2707
NPI assigned
Jan 30, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 22316 MD Primary

Addresses

Primary practice location

6011 University Blvd Ste 120
Ellicott City, MD 21043-6104

Mailing address

6011 University Blvd Ste 120
Ellicott City, MD 21043-6104
Phone (410) 203-0391

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120309000221 DC Practitioner - Physical Therapist in Private Practice 3971762006 Reassigns benefits to 1 organization
I20240715001058 MD Practitioner - Physical Therapist in Private Practice 3971762006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Howard County Physical Therapy Sports RehabilitationGroup PAC ID 7214836428, 4 clinicians

Practice addresses (Care Compare)

6011 University Blvd
Suite 120
Ellicott City, MD 21043-6104
Phone (410) 203-0391

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mosaddegh Physical Therapy Inc Physical Therapist CurrentSince Nov 14, 2022 Accepting new patients
Howard County Physical Therapy Sports Rehabilitation CurrentSince Jun 11, 2024 Accepting new patients

Locations

6011 University Blvd
Ste 120
Ellicott City, MD 21043
Phone (410) 203-0391

7500 Hanover Pkwy
Ste 103
Greenbelt, MD 20770
Phone (301) 446-1644

17902 Georgia Ave
Ste 220
Olney, MD 20832

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1659558724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6011 UNIVERSITY BLVD STE 120",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436104",
            "telephone_number": "410-203-0391",
            "fax_number": "410-203-2707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6011 UNIVERSITY BLVD STE 120",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436104",
            "telephone_number": "410-203-0391",
            "fax_number": "410-203-2707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "BRIAN",
        "middle_name": "AVERY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-30",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "22316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.