Provider Demographics
NPI:1114975026
Name:WILLIAMS, JENNIFER B (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:B
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3014 WADE HAMPTON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-2716
Mailing Address - Country:US
Mailing Address - Phone:864-363-7046
Mailing Address - Fax:
Practice Address - Street 1:3014 WADE HAMPTON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2716
Practice Address - Country:US
Practice Address - Phone:864-363-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist