Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 001620 | WV |
N | 225200000X | Physical Therapy Assistant | A3491 | MD |
N | 225700000X | Massage Therapist | R00752 | MD |
NPI | 1013290741 |
---|---|
Provider Name | Dakari Williams |
First Address | Shepherdstown, WV 25443-4305 |
Second Address | Shepherdstown, WV 25443-4305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2011 |
Last Update Date | 21/09/2011 |