Provider Demographics
NPI:1982647905
Name:WILLIAMS, DORSEY (PT)
Entity Type:Individual
Prefix:MR
First Name:DORSEY
Middle Name:
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:PO BOX 751069
Mailing Address - Street 2:ECU PHYSICIANS PHYSICAL THERPAY
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2325 STANTONSBURG RD
Practice Address - Street 2:ECU PHYSICIANS PHYSICAL THERAPY
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7534
Practice Address - Country:US
Practice Address - Phone:252-695-6322
Practice Address - Fax:252-695-6321
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138CMOtherBCBS NC
NC7212238Medicaid
NC2505736Medicare ID - Type Unspecified