Healthcare Provider Details

I. General information

NPI: 1689342412
Provider Name (Legal Business Name): WILLIAMS PT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W 78TH ST FRNT 1
NEW YORK NY
10024-6755
US

IV. Provider business mailing address

113 W 78TH ST FRNT 1
NEW YORK NY
10024-6755
US

V. Phone/Fax

Practice location:
  • Phone: 516-967-7742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL WILLIAMS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 347-427-4228