Provider Demographics
NPI:1891035382
Name:WILLIAMS, DARYL R (DPT)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:R
Last Name:WILLIAMS
Suffix:
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 1:3810 ZARING MILL CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3052
Mailing Address - Country:US
Mailing Address - Phone:502-767-5228
Mailing Address - Fax:
Practice Address - Street 1:3052 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3020
Practice Address - Country:US
Practice Address - Phone:502-454-5544
Practice Address - Fax:502-454-5562
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKO80280OtherMEDICARE PTAN