Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT022826 | PA |
NPI | 1003248022 |
---|---|
Provider Name | Dr. Allen Kohl Williams III |
First Address | Wyalusing, PA 18853-7803 |
Second Address | Wyalusing, PA 18853-7803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2013 |
Last Update Date | 01/08/2013 |