Provider Demographics
NPI:1811545296
Name:WILLIAMS, KASSI SUE (DPT)
Entity Type:Individual
Prefix:
First Name:KASSI
Middle Name:SUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10824 OLD MILL RD STE 10-1
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2642
Mailing Address - Country:US
Mailing Address - Phone:402-680-1823
Mailing Address - Fax:402-991-3051
Practice Address - Street 1:10824 OLD MILL RD STE 10-1
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2642
Practice Address - Country:US
Practice Address - Phone:402-680-1823
Practice Address - Fax:402-991-3051
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE39942251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics