Provider Demographics
NPI:1841738267
Name:WILLIAMS, VINCENT JR (DPT)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:WILLIAMS
Suffix:JR
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 1:4668 PEMBROKE BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6423
Mailing Address - Country:US
Mailing Address - Phone:757-648-8562
Mailing Address - Fax:757-648-8564
Practice Address - Street 1:4668 PEMBROKE BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455
Practice Address - Country:US
Practice Address - Phone:757-648-8562
Practice Address - Fax:757-648-8564
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist