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General NPI Number Information
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NPI Number | 1508388133
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Entity Type | Organization
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Legal Business Name | WILLIAMS PERFORMANCE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/14/2017
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 18510 E SAN TAN BLVD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-7186
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Country | US
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Telephone | 480-272-2141
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 2175
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City | QUEEN CREEK
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State | AZ
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Zip | 85142
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Country | US
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Telephone | 480-272-2141
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | KEVIN WILLIAMS
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Credential | PT, DPT, CSCS
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Telephone | 480-272-2141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 12486
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License Number State | AZ
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