Provider Demographics
NPI:1083323745
Name:WILLIAMS, CHYNISE ANTOINETTE (LMT)
Entity Type:Individual
Prefix:
First Name:CHYNISE
Middle Name:ANTOINETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 VICTORY GARDEN DR APT 158
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3253
Mailing Address - Country:US
Mailing Address - Phone:850-755-3771
Mailing Address - Fax:
Practice Address - Street 1:410 VICTORY GARDEN DR APT 158
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3253
Practice Address - Country:US
Practice Address - Phone:850-755-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist