Provider Demographics
NPI:1740895903
Name:WILLIAMSON, CONNOR ALLEN
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:ALLEN
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 CAMERADO DR
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8864
Mailing Address - Country:US
Mailing Address - Phone:530-676-7184
Mailing Address - Fax:530-676-7138
Practice Address - Street 1:1060 CAMERADO DR
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8864
Practice Address - Country:US
Practice Address - Phone:530-676-7184
Practice Address - Fax:530-676-7138
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist