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General NPI Number Information
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NPI Number | 1578716825
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Entity Type | Individual
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Provider Name | KELLY ANN WILLIAMS PTA
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Gender | Female
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 325 N SAINT PAUL ST SUITE 4200
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City | DALLAS
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State | TX
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Zip | 75201-3801
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Country | US
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Telephone | 866-217-8404
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Fax |
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Provider Business Mailing Address
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Address Line | 14508 CROSSWAY CT
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City | CHESTERFIELD
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State | MO
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Zip | 63017-8015
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Country | US
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Telephone | 314-809-7116
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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 | TE008086
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 20800
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2005027557
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License Number State | MO
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