Provider Demographics
NPI:1801810650
Name:WILLIAMS, DENISE D (LMT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 RACETRACK RD NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-4612
Mailing Address - Country:US
Mailing Address - Phone:850-314-6642
Mailing Address - Fax:850-362-6521
Practice Address - Street 1:417 RACETRACK RD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-4612
Practice Address - Country:US
Practice Address - Phone:850-314-6642
Practice Address - Fax:850-362-6521
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37028174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist