Provider Demographics
NPI:1629106653
Name:WILLIAMS, CAROLEE S (PTA)
Entity Type:Individual
Prefix:
First Name:CAROLEE
Middle Name:S
Last Name:WILLIAMS
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 1:6935 NICHOLS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-1802
Mailing Address - Country:US
Mailing Address - Phone:904-779-6794
Mailing Address - Fax:
Practice Address - Street 1:7749 NORMANDY BLVD
Practice Address - Street 2:SUITE 147
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-7657
Practice Address - Country:US
Practice Address - Phone:904-786-5576
Practice Address - Fax:904-786-9907
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19079225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant