Provider Demographics
NPI:1174196489
Name:WILLIAMS, DENISE DANIELLE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:DANIELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:LA VETA
Mailing Address - State:CO
Mailing Address - Zip Code:81055-0472
Mailing Address - Country:US
Mailing Address - Phone:512-294-8665
Mailing Address - Fax:719-738-4556
Practice Address - Street 1:23500 US HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:WALSENBURG
Practice Address - State:CO
Practice Address - Zip Code:81089-9524
Practice Address - Country:US
Practice Address - Phone:719-738-5155
Practice Address - Fax:719-738-4556
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0015827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist