Healthcare Provider Details

I. General information

NPI: 1730923780
Provider Name (Legal Business Name): NICKEISHA NICOLE WILLIAMS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 N TRYON ST
CHARLOTTE NC
28262-3300
US

IV. Provider business mailing address

101 E WT HARRIS BLVD
CHARLOTTE NC
28262-3485
US

V. Phone/Fax

Practice location:
  • Phone: 704-863-1925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23674
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP060803T
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: