Healthcare Provider Details

I. General information

NPI: 1366560153
Provider Name (Legal Business Name): WILLIAM KENNETH WILLIAMS JR. PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 HONEYSUCKLE HILLS DR
REDFIELD AR
72132-9370
US

IV. Provider business mailing address

104 HONEYSUCKLE HILLS DR
REDFIELD AR
72132-9370
US

V. Phone/Fax

Practice location:
  • Phone: 501-397-7698
  • Fax: 501-397-7698
Mailing address:
  • Phone: 501-397-7698
  • Fax: 501-397-7698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT1245
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: