Provider Demographics
NPI:1114025384
Name:WILLIAMS, LINDA SUSAN (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 JOHNSTON ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2515
Mailing Address - Country:US
Mailing Address - Phone:256-340-9708
Mailing Address - Fax:256-340-9624
Practice Address - Street 1:12831 6TH ST
Practice Address - Street 2:UNIT C
Practice Address - City:LILLIAN
Practice Address - State:AL
Practice Address - Zip Code:36549-4166
Practice Address - Country:US
Practice Address - Phone:251-961-0090
Practice Address - Fax:251-961-0092
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7521225100000X
MSPT 3554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1003819608OtherGROUP NPI
AL529917620Medicaid
AL529917620Medicaid