Provider Demographics
NPI:1356798292
Name:WILLIAMS, PAUL (DPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
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 1:619 POLE LINE RD
Mailing Address - Street 2:APT. 141
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-5416
Mailing Address - Country:US
Mailing Address - Phone:321-501-7779
Mailing Address - Fax:
Practice Address - Street 1:619 POLE LINE RD
Practice Address - Street 2:APT. 141
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-5416
Practice Address - Country:US
Practice Address - Phone:321-501-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist