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General NPI Number Information
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NPI Number | 1912501636
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Entity Type | Individual
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Provider Name | VICKTORIA AMME' WILLIAMS PTA
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Gender | Female
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 101 EUCALYPTUS AVE
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City | CRESCENT CITY
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State | FL
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Zip | 32112-2407
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Country | US
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Telephone | 386-698-0841
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 460
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City | LAKE COMO
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State | FL
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Zip | 32157-0460
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Country | US
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Telephone | 386-643-5000
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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 | PTA30684
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License Number State | FL
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