MEDICARE: MRS. ASHLEY MARIE 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	261QP2000X	Physical Therapy Clinic/Center	PTA 20254	FL
2	225200000X	Physical Therapy Assistant	PTA20254	FL

General Provider Information

NPI Number	:	1629259239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY MARIE WILLIAMS PTA

Provider Business Mailing Address
First Line	:	1326 4TH AVE SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-6465
Country	:	US
Telephone Number	:	772-978-5676
Fax Number	:

Provider Business Practice Location Address
First Line	:	1326 4TH AVE SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-6465
Country	:	US
Telephone Number	:	772-978-5676
Fax Number	:

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

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	03/19/2013

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