Healthcare Provider Details

I. General information

NPI: 1285571463
Provider Name (Legal Business Name): JOHNITA ANTONETTE WILLIAMS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WILLIES LN
STAFFORD VA
22554-2832
US

IV. Provider business mailing address

21 WILLIES LN
STAFFORD VA
22554-2832
US

V. Phone/Fax

Practice location:
  • Phone: 703-622-1596
  • Fax:
Mailing address:
  • Phone: 703-622-1596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number0019015637
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: