Provider Demographics
NPI:1184440075
Name:WILLIAMS, MATTHEW JOSHUA (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSHUA
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10205 LURLINE AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-7332
Mailing Address - Country:US
Mailing Address - Phone:818-634-4779
Mailing Address - Fax:
Practice Address - Street 1:10515 BALBOA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6350
Practice Address - Country:US
Practice Address - Phone:818-363-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist