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NPI Code Detail

MEDICARE: MRS. DONNA LOU WILLIAMS P.T.

MEDICARE: MRS. DONNA LOU WILLIAMS P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist10157-024WI

General Provider Information

NPI Number : 1629308812
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONNA LOU WILLIAMS P.T.
Provider Business Mailing Address
First Line : 4805 N NEWHALL ST
Second Line :
City : WHITEFISH BAY
State : WI
Zip : 53217-6047
Country : US
Telephone Number : 414-961-0728
Fax Number :
Provider Business Practice Location Address
First Line : 2115 E WOODSTOCK PL
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-1342
Country : US
Telephone Number : 414-271-1020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2010
Last Update Date : 01/11/2010

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