Provider Demographics
NPI:1720375744
Name:WILLIAMS, TRAVIS T (DPT)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-7356
Mailing Address - Country:US
Mailing Address - Phone:850-683-0077
Mailing Address - Fax:850-683-0099
Practice Address - Street 1:610 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-7356
Practice Address - Country:US
Practice Address - Phone:850-683-0077
Practice Address - Fax:850-683-0099
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist