Provider Demographics
NPI:1003241399
Name:WILLIAMS, MILLER EDWARD (PT)
Entity Type:Individual
Prefix:
First Name:MILLER
Middle Name:EDWARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 DAVE WARD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8679
Mailing Address - Country:US
Mailing Address - Phone:501-327-1730
Mailing Address - Fax:
Practice Address - Street 1:2425 DAVE WARD DR STE 103
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8679
Practice Address - Country:US
Practice Address - Phone:501-327-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist