Provider Demographics
NPI:1013187475
Name:WILLIAMS, ANDREW WATTS JR (LMT,MLD/CDP)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:WATTS
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:LMT,MLD/CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MCABEE CT
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4727
Mailing Address - Country:US
Mailing Address - Phone:850-982-1027
Mailing Address - Fax:
Practice Address - Street 1:100 MCABEE CT
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4727
Practice Address - Country:US
Practice Address - Phone:850-982-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31066225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist