Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT018859 | PA |
NPI | 1003007246 |
---|---|
Provider Name | Jessica L Williams |
First Address | Mc Clure, PA 17841-8868 |
Second Address | Lewistown, PA 17044-2160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 25/06/2008 |