Provider Demographics
NPI:1700960473
Name:WILLIAMS, PHILLIP ROBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ROBERT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 CENTER DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3851
Mailing Address - Country:US
Mailing Address - Phone:859-623-2057
Mailing Address - Fax:859-623-2058
Practice Address - Street 1:1054 CENTER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3851
Practice Address - Country:US
Practice Address - Phone:859-623-2057
Practice Address - Fax:859-623-2058
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist