MEDICARE: KEVIN WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02272	OTHER	MO	LICENSE #

General Provider Information

NPI Number	:	1003919937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN WILLIAMS

Provider Business Mailing Address
First Line	:	28806 E BETH CT
Second Line	:
City	:	GRAIN VALLEY
State	:	MO
Zip	:	64029-9610
Country	:	US
Telephone Number	:	816-228-8905
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 NE MOCK AVE
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2439
Country	:	US
Telephone Number	:	816-229-9640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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