Provider Demographics
NPI:1356371801
Name:WILLIAMS, LADONNA ROCHELLE (RPT)
Entity type:Individual
Prefix:
First Name:LADONNA
Middle Name:ROCHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:LADONNA
Other - Middle Name:R
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:100 KIMBERLY CV
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-9719
Mailing Address - Country:US
Mailing Address - Phone:601-454-5292
Mailing Address - Fax:601-454-5292
Practice Address - Street 1:5250 GALAXIE DR
Practice Address - Street 2:SUITE K
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4311
Practice Address - Country:US
Practice Address - Phone:601-368-4570
Practice Address - Fax:601-368-4571
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist