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General NPI Number Information
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NPI Number | 1700684081
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Entity Type | Individual
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Provider Name | JUSTIN TYRELL WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 500 N WASHINGTON AVE STE 107
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City | TITUSVILLE
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State | FL
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Zip | 32796-2759
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Country | US
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Telephone | 321-269-0800
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Fax | 321-383-0404
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Provider Business Mailing Address
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Address Line | 500 N WASHINGTON AVE STE 107
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City | TITUSVILLE
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State | FL
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Zip | 32796-2759
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Country | US
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Telephone | 321-269-0800
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Fax | 321-383-0404
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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 | 33893
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License Number State | FL
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