Provider Demographics
NPI:1295136174
Name:WILLIAMS, NICHOLAS CURTIS (ATC/LAT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CURTIS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 PORPOISE LN
Mailing Address - Street 2:
Mailing Address - City:RIVA
Mailing Address - State:MD
Mailing Address - Zip Code:21140-1106
Mailing Address - Country:US
Mailing Address - Phone:443-286-1716
Mailing Address - Fax:
Practice Address - Street 1:8730 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-2867
Practice Address - Country:US
Practice Address - Phone:301-934-2251
Practice Address - Fax:301-934-7697
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00003072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer