Provider Demographics
NPI:1255420683
Name:WILLIAMS, JOHN E (RPT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 NEW HOPE ROAD
Mailing Address - Street 2:#10 MEDICAL ARTS CLINIC
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740
Mailing Address - Country:US
Mailing Address - Phone:304-425-8853
Mailing Address - Fax:304-425-8853
Practice Address - Street 1:100 NEW HOPE ROAD
Practice Address - Street 2:#10 MEDICAL ARTS CLINIC
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740
Practice Address - Country:US
Practice Address - Phone:304-425-8853
Practice Address - Fax:304-425-8853
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV67225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0156570000Medicaid
WV0156570000Medicaid