Healthcare Provider Details

I. General information

NPI: 1447979695
Provider Name (Legal Business Name): TIA WILLIAMS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 BOARDWALK
NORMAN OK
73069-6332
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 405-447-1991
  • Fax:
Mailing address:
  • Phone: 423-206-4158
  • Fax: 717-773-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6246
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: