Provider Demographics
NPI:1922211283
Name:WILLIAMS-MUHAMMAD, JAMEKA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:JAMEKA
Middle Name:L
Last Name:WILLIAMS-MUHAMMAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JAMEKA
Other - Middle Name:L
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:9912 S FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1440
Mailing Address - Country:US
Mailing Address - Phone:773-941-9245
Mailing Address - Fax:773-821-0396
Practice Address - Street 1:9912 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1440
Practice Address - Country:US
Practice Address - Phone:773-941-9245
Practice Address - Fax:773-821-0396
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3643225100000X
IL070015850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01535097Medicaid