Provider Demographics
NPI:1821133414
Name:WILLIAMS, LISA A (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 1ST AVE
Mailing Address - Street 2:APT 16J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4629
Mailing Address - Country:US
Mailing Address - Phone:917-375-4641
Mailing Address - Fax:
Practice Address - Street 1:141 E 55TH ST
Practice Address - Street 2:4C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4030
Practice Address - Country:US
Practice Address - Phone:917-375-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5582837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQT0331Medicare ID - Type Unspecified