Provider Demographics
NPI:1730497439
Name:WILLIAMS, PAUL DEAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DEAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-6846
Mailing Address - Country:US
Mailing Address - Phone:979-245-3957
Mailing Address - Fax:
Practice Address - Street 1:1307 W GAYLE ST
Practice Address - Street 2:
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-3274
Practice Address - Country:US
Practice Address - Phone:361-782-3573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000603852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer