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General NPI Number Information
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NPI Number | 1396398988
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Entity Type | Individual
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Provider Name | MR. RANDY WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 1665 M ST
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City | FRESNO
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State | CA
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Zip | 93721-1121
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Country | US
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Telephone | 386-275-9732
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Fax |
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Provider Business Mailing Address
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Address Line | 327 WILDER BLVD APT B302
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-7022
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Country | US
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Telephone | 386-275-9732
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA48969
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License Number State | CA
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