Provider Demographics
NPI:1588193635
Name:MCWILLIAMS, JENNIFER MAXWELL (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAXWELL
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LENOVER RD
Mailing Address - Street 2:
Mailing Address - City:ATGLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19310-1763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 LENOVER RD
Practice Address - Street 2:
Practice Address - City:ATGLEN
Practice Address - State:PA
Practice Address - Zip Code:19310-1763
Practice Address - Country:US
Practice Address - Phone:610-593-4824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1002922208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATE1002922OtherPTA