Provider Demographics
NPI:1144573114
Name:WILLIAMS, DUANE A (PT, DSC, MA)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT, DSC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 UNIVERSITY PKWY
Mailing Address - Street 2:BOX 70403
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-6500
Mailing Address - Country:US
Mailing Address - Phone:423-439-4071
Mailing Address - Fax:423-439-4060
Practice Address - Street 1:807 UNIVERSITY PKWY
Practice Address - Street 2:BOX 70403
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-6500
Practice Address - Country:US
Practice Address - Phone:423-439-4071
Practice Address - Fax:423-439-4060
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000001193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPT0000001193OtherST LIC