Provider Demographics
NPI:1649374885
Name:WILLIAMS, PAUL L (MPT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 TELEGRAPH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3464
Mailing Address - Country:US
Mailing Address - Phone:805-642-4678
Mailing Address - Fax:805-642-2038
Practice Address - Street 1:3737 TELEGRAPH RD
Practice Address - Street 2:SUITE A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3464
Practice Address - Country:US
Practice Address - Phone:805-642-4678
Practice Address - Fax:805-642-2038
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT5797BMedicare ID - Type UnspecifiedPHYSICAL THERAPIST