MEDICARE: STEPHANIE LEE WILLIAMS PTA

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	225200000X	Physical Therapy Assistant	PTA4284	TN

General Provider Information

NPI Number	:	1376854349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LEE WILLIAMS PTA

Provider Business Mailing Address
First Line	:	1810 SHADY BROOK ST STE 3
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3993
Country	:	US
Telephone Number	:	931-388-8500
Fax Number	:	931-388-8526

Provider Business Practice Location Address
First Line	:	1810 SHADY BROOK ST STE 3
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3993
Country	:	US
Telephone Number	:	931-388-8500
Fax Number	:	931-388-8526

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

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	05/29/2013

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