Healthcare Provider Details

I. General information

NPI: 1134731706
Provider Name (Legal Business Name): JULIANNE WILLIAMSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIANNE BAL DPT

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 MACCORKLE AVE SW STE 100
CHARLESTON WV
25303-1207
US

IV. Provider business mailing address

1500 GRAND CENTRAL AVE STE 101
VIENNA WV
26105-1079
US

V. Phone/Fax

Practice location:
  • Phone: 304-746-3704
  • Fax: 304-744-5891
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: