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General NPI Number Information
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NPI Number | 1275053936
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Entity Type | Individual
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Provider Name | JEFFREY WILLIAMS LAT, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 06/23/2017
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Provider Practice Location Address
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Address Line | 2702 TANGLE WOOD DR.
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City | COMMERCE
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State | TX
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Zip | 75428
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Country | US
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Telephone | 727-599-6162
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Fax |
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Provider Business Mailing Address
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Address Line | 2702 TANGLEWOOD DR
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City | COMMERCE
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State | TX
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Zip | 75428-3810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT6673
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License Number State | TX
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