Provider Demographics
NPI:1326296971
Name:WILLIAMSON, TEREA S (DPT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:TEREA
Middle Name:S
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:TEREA
Other - Middle Name:S
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, ATC
Mailing Address - Street 1:201 PENNSYLVANIA PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2301
Mailing Address - Country:US
Mailing Address - Phone:317-817-1200
Mailing Address - Fax:317-208-1551
Practice Address - Street 1:207 PENNSYLVANIA PKW
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1393
Practice Address - Country:US
Practice Address - Phone:317-817-1200
Practice Address - Fax:317-867-1220
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009100A225100000X
IN36001001A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer