Provider Demographics
NPI:1972508208
Name:WILLIAMS, AARON H (PT)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:H
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3654 W ANTHEM WAY
Mailing Address - Street 2:STE B102
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0455
Mailing Address - Country:US
Mailing Address - Phone:623-551-9706
Mailing Address - Fax:623-551-9708
Practice Address - Street 1:3654 W ANTHEM WAY
Practice Address - Street 2:STE B102
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0455
Practice Address - Country:US
Practice Address - Phone:623-551-9706
Practice Address - Fax:623-551-9708
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ740515Medicaid
AZZ72590Medicare PIN