Provider Demographics
NPI:1477793248
Name:WILLIAMS, SHANTAE LEIGH (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHANTAE
Middle Name:LEIGH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR STE 830
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-8702
Mailing Address - Country:US
Mailing Address - Phone:312-926-8811
Mailing Address - Fax:312-926-8815
Practice Address - Street 1:680 N LAKE SHORE DR STE 830
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-8702
Practice Address - Country:US
Practice Address - Phone:312-926-8811
Practice Address - Fax:312-926-8815
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist