Provider Demographics
NPI:1437681822
Name:WILLIAMS, HALLIANDA MARIE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:HALLIANDA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:HALLIANDA
Other - Middle Name:MARIE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:10701 W. MANSLICK RD.
Mailing Address - Street 2:
Mailing Address - City:FAIRDALE
Mailing Address - State:KY
Mailing Address - Zip Code:40118
Mailing Address - Country:US
Mailing Address - Phone:502-367-2112
Mailing Address - Fax:502-367-7799
Practice Address - Street 1:10701 W MANSLICK RD
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:KY
Practice Address - Zip Code:40118-9581
Practice Address - Country:US
Practice Address - Phone:502-367-2112
Practice Address - Fax:502-367-7799
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170836225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist