Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3773 | AR |
NPI | 1003241399 |
---|---|
Provider Name | Miller Edward Williams |
First Address | Conway, AR 72034-8679 |
Second Address | Conway, AR 72034-8679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2013 |
Last Update Date | 05/09/2013 |