Healthcare Provider Details

I. General information

NPI: 1144700170
Provider Name (Legal Business Name): KALI SUZANNE WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 S MAJOR DR
BEAUMONT TX
77707-5019
US

IV. Provider business mailing address

965 MAGNOLIA TRCE
SILSBEE TX
77656-3152
US

V. Phone/Fax

Practice location:
  • Phone: 409-861-4611
  • Fax:
Mailing address:
  • Phone: 409-828-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0219816
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: