Provider Demographics
NPI:1083846042
Name:WILLIAMSON, CHAZ DANIEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:CHAZ
Middle Name:DANIEL
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:DANIEL
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:4875 MILLS CIVIC PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-5268
Mailing Address - Country:US
Mailing Address - Phone:515-440-6700
Mailing Address - Fax:515-440-6715
Practice Address - Street 1:4875 MILLS CIVIC PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-5268
Practice Address - Country:US
Practice Address - Phone:515-440-6700
Practice Address - Fax:515-440-6715
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist