Provider Demographics
NPI:1164963781
Name:WILLIAMS, JENEE L (PTA)
Entity Type:Individual
Prefix:MISS
First Name:JENEE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 ESTATE ROSS
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-4600
Mailing Address - Country:US
Mailing Address - Phone:340-779-4678
Mailing Address - Fax:
Practice Address - Street 1:1001 ESTATE ROSS
Practice Address - Street 2:SUITE 6
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-4600
Practice Address - Country:US
Practice Address - Phone:340-779-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6109225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant