Provider Demographics
NPI:1346463312
Name:WILLIAMS, VIRGINIA MEREDITH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:MEREDITH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4809
Mailing Address - Country:US
Mailing Address - Phone:843-412-3791
Mailing Address - Fax:
Practice Address - Street 1:229 SHORE T RD
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-1974
Practice Address - Country:US
Practice Address - Phone:843-412-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4901225100000X
FL23098225100000X
MA17606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist