Provider Demographics
NPI:1710664081
Name:WILLIAMS, SEAN CHRISTOPHER (PTA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:CHRISTOPHER
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 1:47 MAPLE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551
Mailing Address - Country:US
Mailing Address - Phone:315-483-2000
Mailing Address - Fax:315-483-6805
Practice Address - Street 1:47 MAPLE AVE. SUITE 300
Practice Address - Street 2:SUITE 300
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551
Practice Address - Country:US
Practice Address - Phone:315-483-2000
Practice Address - Fax:315-483-6805
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002023225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant