Provider Demographics
NPI:1467903849
Name:WILLIAMS, BRIANNE M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:MW
Other - Last Name:VANDYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 CONGRESS PL
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2946
Mailing Address - Country:US
Mailing Address - Phone:920-205-4840
Mailing Address - Fax:
Practice Address - Street 1:1000 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1116
Practice Address - Country:US
Practice Address - Phone:920-727-9878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13105-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist