Provider Demographics
NPI:1043431562
Name:WILLIAMS, STEFFANY O (LPT)
Entity Type:Individual
Prefix:
First Name:STEFFANY
Middle Name:O
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 OLD FARM ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443
Mailing Address - Country:US
Mailing Address - Phone:910-619-0257
Mailing Address - Fax:910-270-8801
Practice Address - Street 1:146 OLD FARM ROAD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443
Practice Address - Country:US
Practice Address - Phone:910-619-0257
Practice Address - Fax:910-270-8801
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93462251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211432Medicaid