MEDICARE: STEPHEN WILLIAMSON DPT

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	24628	MD
2	225100000X	Physical Therapist	PT41143	FL

General Provider Information

NPI Number	:	1053744904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN WILLIAMSON DPT

Provider Business Mailing Address
First Line	:	423 BLUE HAMPTON DR
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-1090
Country	:	US
Telephone Number	:	201-953-2472
Fax Number	:

Provider Business Practice Location Address
First Line	:	465 TOWN PLAZA AVE STE B
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32081-5190
Country	:	US
Telephone Number	:	904-222-3780
Fax Number	:

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

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	06/25/2024

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