Provider Demographics
NPI:1609120989
Name:WILLIAMS, LAVET E
Entity Type:Individual
Prefix:
First Name:LAVET
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3038
Mailing Address - Country:US
Mailing Address - Phone:321-474-2148
Mailing Address - Fax:
Practice Address - Street 1:5275 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-8741
Practice Address - Country:US
Practice Address - Phone:407-730-3980
Practice Address - Fax:407-730-3981
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist