Healthcare Provider Details

I. General information

NPI: 1649332933
Provider Name (Legal Business Name): NICHOLE L WILLIAMS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICHOLE WHITFIELD DPT

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 MEADOWBROOK LN
CHESAPEAKE VA
23321-5440
US

IV. Provider business mailing address

5301 PROVIDENCE RD SUITE 80
VIRGINIA BEACH VA
23464-4128
US

V. Phone/Fax

Practice location:
  • Phone: 757-651-1137
  • Fax: 757-606-2520
Mailing address:
  • Phone: 757-467-1900
  • Fax: 757-489-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204900
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: