Healthcare Provider Details

I. General information

NPI: 1093808354
Provider Name (Legal Business Name): JANET BROOKS WILLIAMS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2993 SUNSET BLVD
WEST COLUMBIA SC
29169-3421
US

IV. Provider business mailing address

209 BARNACLE CIR
LEXINGTON SC
29072-9353
US

V. Phone/Fax

Practice location:
  • Phone: 803-939-0026
  • Fax:
Mailing address:
  • Phone: 803-358-9742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number977
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: