MEDICARE: ROBERT 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	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1688	OTHER	NC	LICENSE #

General Provider Information

NPI Number	:	1477663938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT WILLIAMS

Provider Business Mailing Address
First Line	:	5828 ROWSGATE LN
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-7091
Country	:	US
Telephone Number	:	910-452-7644
Fax Number	:

Provider Business Practice Location Address
First Line	:	8066 MARKET ST # B
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-9384
Country	:	US
Telephone Number	:	910-686-8485
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ ROBERT WILLIAMS ” Practice Location

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