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General NPI Number Information
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NPI Number | 1801673603
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Entity Type | Individual
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Provider Name | BRYAN WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 22601 CAMINO DEL MAR
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City | BOCA RATON
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State | FL
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Zip | 33433-6516
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Country | US
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Telephone | 561-544-6209
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Fax |
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Provider Business Mailing Address
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Address Line | 5225 NW 73RD TER
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City | LAUDERHILL
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State | FL
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Zip | 33319-6316
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Country | US
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Telephone | 954-673-5788
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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 | 30973
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License Number State | FL
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