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General NPI Number Information
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NPI Number | 1841536844
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Entity Type | Organization
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Legal Business Name | WILLIAMSON PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 141 EAST 2ND AVE., SUITE 100
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City | WILLIAMSON
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State | WV
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Zip | 25661-0141
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Country | US
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Telephone | 606-855-0346
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Fax |
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Provider Business Mailing Address
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Address Line | 145 AUSTIN ROAD
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City | JENKINS
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State | KY
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Zip | 41537-0145
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Country | US
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Telephone | 606-855-0346
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DELLA JEAN BENTLEY
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Credential |
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Telephone | 606-855-0346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 004537
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License Number State | KY
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