Provider Demographics
NPI:1043850902
Name:WILLIAMS, RAYMOND PETER JR (PTA)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:PETER
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 NW 59TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-2459
Mailing Address - Country:US
Mailing Address - Phone:907-347-0818
Mailing Address - Fax:
Practice Address - Street 1:2051 NW 112TH AVE STE 125
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-1835
Practice Address - Country:US
Practice Address - Phone:305-878-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28758225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant