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NPI Code Detail

MEDICARE: DALLAS WILLIAMS P.T.

MEDICARE: DALLAS 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 Therapist1115400TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
185643TOTHERTXBLUECROSS BLUESHIELD

General Provider Information

NPI Number : 1962557074
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALLAS WILLIAMS P.T.
Provider Business Mailing Address
First Line : 127 MEDICAL PARK LN
Second Line :
City : HUNTSVILLE
State : TX
Zip : 77340-4972
Country : US
Telephone Number : 936-294-0283
Fax Number : 936-294-9878
Provider Business Practice Location Address
First Line : 127 MEDICAL PARK LN
Second Line :
City : HUNTSVILLE
State : TX
Zip : 77340-4972
Country : US
Telephone Number : 936-294-0283
Fax Number : 936-294-9878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 09/01/2012

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