Provider Demographics
NPI:1821622671
Name:WILLIAMS-RAHMAN, JACQUELINE V (LPTA)
Entity Type:Individual
Prefix:PROF
First Name:JACQUELINE
Middle Name:V
Last Name:WILLIAMS-RAHMAN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PINEDALE CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5583
Mailing Address - Country:US
Mailing Address - Phone:682-465-4959
Mailing Address - Fax:
Practice Address - Street 1:10 PINEDALE CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5583
Practice Address - Country:US
Practice Address - Phone:682-465-4959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2031235225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant