Provider Demographics
NPI:1851645543
Name:WILLIAMS, JUSTIN K (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:10128 W BROAD ST
Practice Address - Street 2:FORUM BUILDING III, SUITE K
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6761
Practice Address - Country:US
Practice Address - Phone:804-217-9210
Practice Address - Fax:804-217-9213
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305207727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1851645543OtherMEDICAID QMB
VAC05954OtherGROUP MEDICARE PTAN
VAQ41433AMedicare PIN