Provider Demographics
NPI:1780143172
Name:WILLIAMS, JORDYN RYAH (AT, ATC)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:RYAH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 NANCYWOOD DR APT 1
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-2064
Mailing Address - Country:US
Mailing Address - Phone:412-498-3132
Mailing Address - Fax:
Practice Address - Street 1:1498 NANCYWOOD DR APT 1
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-2064
Practice Address - Country:US
Practice Address - Phone:412-498-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
OHAT0063342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program