Provider Demographics
NPI:1659683183
Name:WILLIAMS, NICHOLAS STEVEN (PTA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:STEVEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 BROWNS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:TN
Mailing Address - Zip Code:38345-7902
Mailing Address - Country:US
Mailing Address - Phone:731-307-0727
Mailing Address - Fax:
Practice Address - Street 1:727 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-1924
Practice Address - Country:US
Practice Address - Phone:731-968-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4790225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant