Provider Demographics
NPI:1598896466
Name:WILLIAMS, CAROLYN CORDELIA (MAPT)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:CORDELIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MAPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 E JEFFERSON AVE
Mailing Address - Street 2:APT. # 24-12
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-4188
Mailing Address - Country:US
Mailing Address - Phone:313-822-9577
Mailing Address - Fax:
Practice Address - Street 1:2301 VAN DYKE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3958
Practice Address - Country:US
Practice Address - Phone:313-866-7363
Practice Address - Fax:313-866-7482
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501000685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501000685OtherPHYSICAL THERAPY LICENSE