Provider Demographics
NPI:1780153023
Name:WILLIAMS, LATISHA LEVELMA (DPT)
Entity type:Individual
Prefix:DR
First Name:LATISHA
Middle Name:LEVELMA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 SAND CREST DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-4857
Mailing Address - Country:US
Mailing Address - Phone:318-423-5606
Mailing Address - Fax:
Practice Address - Street 1:7607 FERN AVE STE 704
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5744
Practice Address - Country:US
Practice Address - Phone:318-828-1450
Practice Address - Fax:318-828-1450
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09078R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist