Provider Demographics
NPI:1326129354
Name:WILLIAMS, CHARLES (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 GRANDVIEW DR E
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-8324
Mailing Address - Country:US
Mailing Address - Phone:620-271-0957
Mailing Address - Fax:
Practice Address - Street 1:1501 E FULTON TER
Practice Address - Street 2:SUITE 1
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6289
Practice Address - Country:US
Practice Address - Phone:620-805-6883
Practice Address - Fax:620-805-6886
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS141115Medicare UPIN