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General NPI Number Information
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NPI Number | 1609298389
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Entity Type | Individual
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Provider Name | AUDREY WILLIAMS DPT
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Gender | Female
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 210 E COLLEGE ST
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City | ENERGY
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State | IL
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Zip | 62933-3568
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Country | US
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Telephone | 618-942-7014
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 JAMIE AVE APT B
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City | MARION
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State | IL
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Zip | 62959-5059
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Country | US
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Telephone |
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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 | 070020191
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License Number State | IL
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