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General NPI Number Information
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NPI Number | 1639950058
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Entity Type | Individual
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Provider Name | SHANE WILLIAMS JR. PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/11/2023
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 17630 VASHON HWY SW
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City | VASHON
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State | WA
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Zip | 98070
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Country | US
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Telephone | 206-657-7879
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Fax |
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Provider Business Mailing Address
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Address Line | 16217 CRESCENT DR SW
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City | VASHON
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State | WA
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Zip | 98070-3741
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Country | US
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Telephone | 810-471-2384
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 61477372
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License Number State | WA
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