Provider Demographics
NPI:1932223419
Name:WILLIAMS, ANDREA KAY (PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39301
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-1023
Mailing Address - Country:US
Mailing Address - Phone:440-570-6157
Mailing Address - Fax:704-688-9724
Practice Address - Street 1:10812 CAMDEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3582
Practice Address - Country:US
Practice Address - Phone:440-570-6157
Practice Address - Fax:704-688-9724
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211971Medicaid