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General NPI Number Information
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NPI Number | 1851645543
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Entity Type | Individual
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Provider Name | JUSTIN K WILLIAMS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 10128 W BROAD ST FORUM BUILDING III, SUITE K
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City | GLEN ALLEN
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State | VA
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Zip | 23060-6761
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Country | US
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Telephone | 804-217-9210
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Fax | 804-217-9213
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Provider Business Mailing Address
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Address Line | 771 PILOT HOUSE DR SUITE A
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-1990
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Country | US
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Telephone | 757-873-2302
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Fax | 757-873-2306
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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 | 2305207727
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License Number State | VA
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