Provider Demographics
NPI:1770751695
Name:MCWILLIAMS, KEVIN L (PT, MPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:MCWILLIAMS
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:109 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2007
Practice Address - Country:US
Practice Address - Phone:660-383-1284
Practice Address - Fax:660-383-1285
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105255225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4370051OtherMEDICARE PTAN
42833037OtherBCBS KC