Provider Demographics
NPI:1891915278
Name:WILLIAMS, JEFFERY SHANE (RPT)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:SHANE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 RIVERTON DR
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-8304
Mailing Address - Country:US
Mailing Address - Phone:256-442-6138
Mailing Address - Fax:
Practice Address - Street 1:525 S 3RD ST STE C
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5350
Practice Address - Country:US
Practice Address - Phone:866-543-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist