Healthcare Provider Details

I. General information

NPI: 1942018148
Provider Name (Legal Business Name): JARRELL WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 N MILITARY TRL STE 401
WEST PALM BEACH FL
33410-6295
US

IV. Provider business mailing address

19 SIDONIA AVE APT 6
CORAL GABLES FL
33134-3427
US

V. Phone/Fax

Practice location:
  • Phone: 561-320-2702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: