Healthcare Provider Details

I. General information

NPI: 1013290741
Provider Name (Legal Business Name): DAKARI WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MADDEX DR
SHEPHERDSTOWN WV
25443-4305
US

IV. Provider business mailing address

80 MADDEX DR
SHEPHERDSTOWN WV
25443-4305
US

V. Phone/Fax

Practice location:
  • Phone: 304-876-9422
  • Fax:
Mailing address:
  • Phone: 304-876-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001620
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA3491
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberR00752
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: