MEDICARE: MS. PHYLLIS ANNETTE 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	18677	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124144704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHYLLIS ANNETTE WILLIAMS

Provider Business Mailing Address
First Line	:	3526 CHILDRESS TER
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-2017
Country	:	US
Telephone Number	:	301-562-1116
Fax Number	:	301-562-1317

Provider Business Practice Location Address
First Line	:	1105 SPRING ST
Second Line	:	STE H
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4026
Country	:	US
Telephone Number	:	301-562-1116
Fax Number	:	301-562-1317

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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