Provider Demographics
NPI:1659422293
Name:WILLIAMS, WILLIAM SAMUEL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SAMUEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10223 W BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584
Mailing Address - Country:US
Mailing Address - Phone:713-436-3900
Mailing Address - Fax:713-436-3904
Practice Address - Street 1:10223 W BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:713-436-3900
Practice Address - Fax:713-436-3904
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1111490OtherTEXAS LICENSE