Healthcare Provider Details

I. General information

NPI: 1619953841
Provider Name (Legal Business Name): CORINNE TERESA WILLIAMS A.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 FARMERS LN SUITE 10
SANTA ROSA CA
95405-6718
US

IV. Provider business mailing address

795 FARMERS LN SUITE 10
SANTA ROSA CA
95405-6718
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-7615
  • Fax: 707-571-8601
Mailing address:
  • Phone: 707-571-7615
  • Fax: 707-571-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT4130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: