MEDICARE: MRS. JOHNITA ANTONETTE WILLIAMS LMT

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	172M00000X	Mechanotherapist	0019015637	VA

General Provider Information

NPI Number	:	1285571463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOHNITA ANTONETTE WILLIAMS LMT

Provider Business Mailing Address
First Line	:	21 WILLIES LN
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-2832
Country	:	US
Telephone Number	:	703-622-1596
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 WILLIES LN
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-2832
Country	:	US
Telephone Number	:	703-622-1596
Fax Number	:

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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