MEDICARE: MS. BLAIR NICOLE WILLIAMS PT

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	225100000X	Physical Therapist	1143584	TX

General Provider Information

NPI Number	:	1811992225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BLAIR NICOLE WILLIAMS PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2051 COPPERWOOD PARK LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-2746
Country	:	US
Telephone Number	:	281-298-5612
Fax Number	:

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	11/05/2024

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