Provider Demographics
NPI:1558012351
Name:WILLIAMS, GLORIA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-5205
Mailing Address - Country:US
Mailing Address - Phone:252-218-5664
Mailing Address - Fax:
Practice Address - Street 1:102 S DISCOVERY ST # 4
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-5778
Practice Address - Country:US
Practice Address - Phone:252-218-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist