Provider Demographics
NPI:1447426515
Name:MCWILLIAMS, JEFFREY MASON (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MASON
Last Name:MCWILLIAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2849 TULLY DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3417
Mailing Address - Country:US
Mailing Address - Phone:540-562-5432
Mailing Address - Fax:
Practice Address - Street 1:214 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1543
Practice Address - Country:US
Practice Address - Phone:540-962-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist