Provider Demographics
NPI:1568220945
Name:RICHARDSWILLIAMS, MAYA (LMT)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:RICHARDSWILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10308 W WINDSOR BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85307-4261
Mailing Address - Country:US
Mailing Address - Phone:480-295-9176
Mailing Address - Fax:
Practice Address - Street 1:15262 N 75TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4763
Practice Address - Country:US
Practice Address - Phone:623-476-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-22899225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation