Healthcare Provider Details

I. General information

NPI: 1881137354
Provider Name (Legal Business Name): JOY DELIVERANCE WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BODY INTEGRITY FITNESS, LLC MLS. CPT, CES

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3863 W FLOURNOY ST APT. 1W
CHICAGO IL
60624-3617
US

IV. Provider business mailing address

PO BOX 440316
CHICAGO IL
60644-0316
US

V. Phone/Fax

Practice location:
  • Phone: 773-575-4512
  • Fax:
Mailing address:
  • Phone: 773-575-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberT72685
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1506535
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberMLS243509
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: