Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2096691 | TX |
NPI | 1003395732 |
---|---|
Provider Name | Ms. Ashley Nicole Williamson |
First Address | Grand Saline, TX 75140-3494 |
Second Address | Grand Saline, TX 75140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2018 |
Last Update Date | 13/08/2018 |