Provider Demographics
NPI:1952387110
Name:WILLIAMS, JASON D (MPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DIANA DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:26288-9078
Mailing Address - Country:US
Mailing Address - Phone:304-847-5682
Mailing Address - Fax:304-847-5608
Practice Address - Street 1:125 DIANA DR
Practice Address - Street 2:
Practice Address - City:WEBSTER SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:26288-9078
Practice Address - Country:US
Practice Address - Phone:304-847-5682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
002530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007237Medicaid
WI4202371Medicare ID - Type Unspecified