Provider Demographics
NPI:1659198125
Name:WILLIAMSON, AMELIA (ATHLETIC TRAINER)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PENN CHARTER DR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4617
Mailing Address - Country:US
Mailing Address - Phone:267-625-5547
Mailing Address - Fax:
Practice Address - Street 1:17 PENN CHARTER DR
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-4617
Practice Address - Country:US
Practice Address - Phone:267-625-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0061392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer