Healthcare Provider Details

I. General information

NPI: 1174823082
Provider Name (Legal Business Name): RENISHA WILLIAMS LMT/COSMETOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2747 W SOUTHERN AVE STE. 7
TEMPE AZ
85282-4249
US

IV. Provider business mailing address

2747 W SOUTHERN AVE STE 7
TEMPE AZ
85282-4240
US

V. Phone/Fax

Practice location:
  • Phone: 602-437-3772
  • Fax:
Mailing address:
  • Phone: 602-312-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number19400823
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-03688P
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: