Provider Demographics
NPI:1700863156
Name:WILLIAMS, TRVERA L (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:TRVERA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3795 E NORTH ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6200
Mailing Address - Country:US
Mailing Address - Phone:864-292-0011
Mailing Address - Fax:864-292-0303
Practice Address - Street 1:3795 E NORTH ST
Practice Address - Street 2:SUITE 14
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6200
Practice Address - Country:US
Practice Address - Phone:864-292-0011
Practice Address - Fax:864-292-0303
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q333076089Medicare ID - Type Unspecified
SCQ33307Medicare UPIN