Healthcare Provider Details

I. General information

NPI: 1801673603
Provider Name (Legal Business Name): BRYAN WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22601 CAMINO DEL MAR
BOCA RATON FL
33433-6516
US

IV. Provider business mailing address

5225 NW 73RD TER
LAUDERHILL FL
33319-6316
US

V. Phone/Fax

Practice location:
  • Phone: 561-544-6209
  • Fax:
Mailing address:
  • Phone: 954-673-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number30973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: