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General NPI Number Information
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NPI Number | 1447426515
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Entity Type | Individual
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Provider Name | JEFFREY MASON MCWILLIAMS PT
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Gender | Male
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 214 W MAIN ST
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City | COVINGTON
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State | VA
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Zip | 24426-1543
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Country | US
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Telephone | 540-962-7112
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Fax |
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Provider Business Mailing Address
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Address Line | 2849 TULLY DR
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City | ROANOKE
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State | VA
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Zip | 24019-3417
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Country | US
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Telephone | 540-562-5432
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305006238
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License Number State | VA
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