MEDICARE: THERESA CLARK WILLIAMSON PT

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	PT 12383	CA

General Provider Information

NPI Number	:	1558344341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA CLARK WILLIAMSON PT

Provider Business Mailing Address
First Line	:	PO BOX 612260
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95161
Country	:	US
Telephone Number	:	877-325-2776
Fax Number	:	408-945-4011

Provider Business Practice Location Address
First Line	:	1688 WILLOW ST
Second Line	:	SUITE K
City	:	SAN JOSE
State	:	CA
Zip	:	95125
Country	:	US
Telephone Number	:	408-264-6643
Fax Number	:	408-264-6652

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	07/08/2007

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