Provider Demographics
NPI:1265980254
Name:WILLIAMS, MAKENZIE M (DPT)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 STATE HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3160
Mailing Address - Country:US
Mailing Address - Phone:607-226-2530
Mailing Address - Fax:
Practice Address - Street 1:5419 STATE HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3160
Practice Address - Country:US
Practice Address - Phone:607-226-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0120312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist