Healthcare Provider Details

I. General information

NPI: 1710370093
Provider Name (Legal Business Name): KRISTOPHER WILLIAMS P.T., D.P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 OWEN DR
FAYETTEVILLE NC
28304-3419
US

IV. Provider business mailing address

121 HIGH SEDGE DR
WINSTON SALEM NC
27107-1855
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-9300
  • Fax: 910-483-9302
Mailing address:
  • Phone: 601-927-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP15455
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: