Provider Demographics
NPI:1417129909
Name:WILLIAMS, CARMEN YVONNE (PT)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:YVONNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 OMAHA CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3572
Mailing Address - Country:US
Mailing Address - Phone:615-545-3556
Mailing Address - Fax:
Practice Address - Street 1:4001 OMAHA CT
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3572
Practice Address - Country:US
Practice Address - Phone:615-545-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5645225100000X
TNPT0000005645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4164379OtherBLUE CROSS BLUE SHILD