Provider Demographics
NPI:1407627300
Name:WILLIAMS, JENNIFER LYNNE (PTA, BS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PTA, BS
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:ENDSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA, BS
Mailing Address - Street 1:306 AMANDA WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-4716
Mailing Address - Country:US
Mailing Address - Phone:940-389-9222
Mailing Address - Fax:
Practice Address - Street 1:609 MEDICAL CENTER DR BLDG 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3866
Practice Address - Country:US
Practice Address - Phone:940-389-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2130007225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant