Provider Demographics
NPI:1982847984
Name:WILLIAMS, JEREMIAH EDWARD SR (PTA)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:EDWARD
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 RIDGELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-2150
Mailing Address - Country:US
Mailing Address - Phone:610-349-9972
Mailing Address - Fax:
Practice Address - Street 1:770 POPLAR CHURCH RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2302
Practice Address - Country:US
Practice Address - Phone:717-763-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7812225200000X
PATE008112225200000X
PATEI002617225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant