Provider Demographics
NPI:1801296066
Name:WILLIAMS, ROXANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12220 IRON BRIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1543
Mailing Address - Country:US
Mailing Address - Phone:757-784-5453
Mailing Address - Fax:
Practice Address - Street 1:12220 IRON BRIDGE RD STE C
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1543
Practice Address - Country:US
Practice Address - Phone:757-784-5453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist