Provider Demographics
NPI:1134151202
Name:WILLIAMS, SEAN (MPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14125 NW 80TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2350
Mailing Address - Country:US
Mailing Address - Phone:305-381-5357
Mailing Address - Fax:305-846-9653
Practice Address - Street 1:4393 SW 130TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4730
Practice Address - Country:US
Practice Address - Phone:954-665-7326
Practice Address - Fax:305-846-9653
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890665300Medicaid
FL890665300Medicaid