Provider Demographics
NPI:1215038484
Name:WILLIAMS, CHARLES E JR (PT, CFCE)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:PT, CFCE
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 16937
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24209-6937
Mailing Address - Country:US
Mailing Address - Phone:276-591-5484
Mailing Address - Fax:276-591-5477
Practice Address - Street 1:136 BRISTOL EAST RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-5500
Practice Address - Country:US
Practice Address - Phone:276-591-5484
Practice Address - Fax:276-591-5477
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA193651OtherANTHEM BLUE CROSS
TN4092102OtherBLUE CROSS BLUE SHIELD
VA7263754OtherAETNA
VAC09246Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
VA7263754OtherAETNA
TN4092102OtherBLUE CROSS BLUE SHIELD
VA00W114F01Medicare PIN