MEDICARE: MS. CAROLYN CORDELIA WILLIAMS MAPT

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	5501000685	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5501000685	OTHER	MI	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1598896466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN CORDELIA WILLIAMS MAPT

Provider Business Mailing Address
First Line	:	9000 E JEFFERSON AVE
Second Line	:	APT. # 24-12
City	:	DETROIT
State	:	MI
Zip	:	48214-4188
Country	:	US
Telephone Number	:	313-822-9577
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 VAN DYKE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-3958
Country	:	US
Telephone Number	:	313-866-7363
Fax Number	:	313-866-7482

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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