Provider Demographics
NPI:1811275282
Name:WILLIAMS, JON MICHAEL (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N LASALLE ST
Mailing Address - Street 2:UNIT 3807
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8539
Mailing Address - Country:US
Mailing Address - Phone:608-931-4745
Mailing Address - Fax:
Practice Address - Street 1:2235 N SHEFFIELD AVE
Practice Address - Street 2:ROOM 120
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3621
Practice Address - Country:US
Practice Address - Phone:773-525-4966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist