MEDICARE: LAUREN 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	P13746	NC

General Provider Information

NPI Number	:	1083168348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN WILLIAMS

Provider Business Mailing Address
First Line	:	554 REDFORD PLACE DR
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-0015
Country	:	US
Telephone Number	:	954-579-1204
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 BENDEMEER LN
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-9731
Country	:	US
Telephone Number	:	919-263-9605
Fax Number	:

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

Provider Enumeration Date	:	08/04/2016
Last Update Date	:	08/04/2016

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