Provider Demographics
NPI:1134475643
Name:WILLIAMS, DEBORAH (LMT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 NEW DORP LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2364
Mailing Address - Country:US
Mailing Address - Phone:718-980-5161
Mailing Address - Fax:718-980-7068
Practice Address - Street 1:97 NEW DORP LN
Practice Address - Street 2:SUITE D
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2364
Practice Address - Country:US
Practice Address - Phone:718-980-5161
Practice Address - Fax:718-980-7068
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005609-1172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist