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NPI Code Detail

MEDICARE: TIFFANY S WILLIAMS PTA

MEDICARE: TIFFANY S WILLIAMS PTA
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
1225200000XPhysical Therapy AssistantPTA47957CA

General Provider Information

NPI Number : 1043782212
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY S WILLIAMS PTA
Provider Business Mailing Address
First Line : 1633 E BIANCHI RD APT 29
Second Line :
City : STOCKTON
State : CA
Zip : 95210-7600
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 442 E HAMPTON ST
Second Line :
City : STOCKTON
State : CA
Zip : 95204-5519
Country : US
Telephone Number : 209-466-0456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2018
Last Update Date : 12/27/2018

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Directions to “ TIFFANY S WILLIAMS PTA” Practice Location

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