Healthcare Provider Details

I. General information

NPI: 1902293095
Provider Name (Legal Business Name): ROBERT J WILLIAMS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 SIDNEY ST
DUNDEE MI
48131-1267
US

IV. Provider business mailing address

238 SIDNEY ST
DUNDEE MI
48131-1267
US

V. Phone/Fax

Practice location:
  • Phone: 734-770-7960
  • Fax:
Mailing address:
  • Phone: 734-770-7960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501001004
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: