Provider Demographics
NPI:1417939869
Name:WILLIAMS, GERALD L (PT)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5245 ARBOR WOOD LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7352
Mailing Address - Country:US
Mailing Address - Phone:409-454-7543
Mailing Address - Fax:
Practice Address - Street 1:8968 KIRBY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2830
Practice Address - Country:US
Practice Address - Phone:409-454-7543
Practice Address - Fax:713-391-8413
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX550275Medicare PIN