Provider Demographics
NPI:1851817860
Name:WILLIAMS, DESIREE JANINE (DPT)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:JANINE
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 1:6308 VISTA DEL MAR APT A
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7512
Mailing Address - Country:US
Mailing Address - Phone:404-434-7774
Mailing Address - Fax:
Practice Address - Street 1:6308 VISTA DEL MAR APT A
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7512
Practice Address - Country:US
Practice Address - Phone:404-434-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2935552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic