MEDICARE: MRS. GRACE WILLIAMS EAST 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	2306606756	VA

General Provider Information

NPI Number	:	1467335166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRACE WILLIAMS EAST PTA

Provider Business Mailing Address
First Line	:	4819 RIVERSIDE DR STE C
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-5581
Country	:	US
Telephone Number	:	434-421-6179
Fax Number	:	434-421-6179

Provider Business Practice Location Address
First Line	:	4819 RIVERSIDE DR STE C
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-5581
Country	:	US
Telephone Number	:	434-421-6179
Fax Number	:	434-421-6179

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

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	07/29/2025

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