MEDICARE: MICHAEL ANDREW WILLIAMS PT, MSPT, MHA

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	294748	CA

General Provider Information

NPI Number	:	1265056006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ANDREW WILLIAMS PT, MSPT, MHA

Provider Business Mailing Address
First Line	:	11165 CAMINITO VISTA SERENA
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3304
Country	:	US
Telephone Number	:	832-647-3812
Fax Number	:

Provider Business Practice Location Address
First Line	:	11165 CAMINITO VISTA SERENA
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3304
Country	:	US
Telephone Number	:	832-647-3812
Fax Number	:

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

Provider Enumeration Date	:	06/07/2020
Last Update Date	:	06/07/2020

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