Provider Demographics
NPI:1639648298
Name:WILLIAMS, MESHACH JOSIAH SR
Entity Type:Individual
Prefix:MR
First Name:MESHACH
Middle Name:JOSIAH
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8610
Mailing Address - Country:US
Mailing Address - Phone:763-312-0203
Mailing Address - Fax:
Practice Address - Street 1:315 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8839
Practice Address - Country:US
Practice Address - Phone:763-312-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist