Healthcare Provider Details

I. General information

NPI: 1417065533
Provider Name (Legal Business Name): JENNIFER M. WILLIAMS P.T., D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER WILLIAMS PT,DPT,CWCS,CSCS

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 NEW WAVERLY PL STE 220
CARY NC
27518-7407
US

IV. Provider business mailing address

1204 SEATTLE SLEW LN
CARY NC
27519-5408
US

V. Phone/Fax

Practice location:
  • Phone: 919-851-0711
  • Fax:
Mailing address:
  • Phone: 516-662-4723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberP11529
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberP11529
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberP11529
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberP11529
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberP11529
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: