Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT1245 | AR |
NPI | 1366560153 |
---|---|
Provider Name | Mr. William Kenneth Williams JR. |
First Address | Redfield, AR 72132-9370 |
Second Address | Redfield, AR 72132-9370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5S345 | BCBS PHYSICAL THERAPIST (01) | AR |