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General NPI Number Information
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NPI Number | 1407383961
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Entity Type | Individual
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Provider Name | MICAH LYNN WILLIAMS LPTA
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Gender | Male
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 05/16/2017
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Provider Practice Location Address
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Address Line | 2415 7TH AVE S
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City | BIRMINGHAM
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State | AL
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Zip | 35233-3317
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Country | US
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Telephone | 205-933-8101
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Fax |
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Provider Business Mailing Address
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Address Line | 2007 VESTAVIA PARK LN APT A
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City | VESTAVIA
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State | AL
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Zip | 35216-3714
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Country | US
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Telephone | 334-313-0371
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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 | PTA7088
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License Number State | AL
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