Provider Demographics
NPI:1619270162
Name:WILLIAMS, MADELYN J (PT)
Entity Type:Individual
Prefix:MS
First Name:MADELYN
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 3RD AVE
Mailing Address - Street 2:#233
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3622
Mailing Address - Country:US
Mailing Address - Phone:228-363-4026
Mailing Address - Fax:
Practice Address - Street 1:1636 3RD AVE
Practice Address - Street 2:#233
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3622
Practice Address - Country:US
Practice Address - Phone:228-363-4026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032966225100000X
LA00517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist