MEDICARE: MRS. KELSEY WILLIAMS PTA

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
1	208100000X	Physical Medicine & Rehabilitation Physician	10916	AL

General Provider Information

NPI Number	:	1720815004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELSEY WILLIAMS PTA

Provider Business Mailing Address
First Line	:	12863 LEE ROAD 379
Second Line	:
City	:	VALLEY
State	:	AL
Zip	:	36854-7021
Country	:	US
Telephone Number	:	334-497-2520
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 S RAILROAD ST STE 14
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-2993
Country	:	US
Telephone Number	:	877-495-7773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2024
Last Update Date	:	09/19/2024

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