MEDICARE: JAMES EDWARD 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	225200000X	Physical Therapy Assistant	TE1000142	PA

General Provider Information

NPI Number	:	1639462195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EDWARD WILLIAMS PTA

Provider Business Mailing Address
First Line	:	2380 BLUE EYE RD
Second Line	:
City	:	COLUMBUS
State	:	PA
Zip	:	16405-3404
Country	:	US
Telephone Number	:	814-664-3698
Fax Number	:

Provider Business Practice Location Address
First Line	:	2380 BLUE EYE RD
Second Line	:
City	:	COLUMBUS
State	:	PA
Zip	:	16405-3404
Country	:	US
Telephone Number	:	814-664-3698
Fax Number	:

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

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	05/17/2011

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