Healthcare Provider Details

I. General information

NPI: 1205138963
Provider Name (Legal Business Name): INGRID WILLIAMS DPT, WCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8927 ERIE AVE
NORTH BEACH MD
20714-5009
US

IV. Provider business mailing address

PO BOX 324
NORTH BEACH MD
20714-0324
US

V. Phone/Fax

Practice location:
  • Phone: 443-305-9577
  • Fax:
Mailing address:
  • Phone: 443-305-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number37357
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number28699
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: