MEDICARE: ASHLEY LYNN MARIE WILLIAMS PT DPT

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	P22908	NC
2	225100000X	Physical Therapist	P22908	NC

General Provider Information

NPI Number	:	1730943556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LYNN MARIE WILLIAMS PT DPT

Provider Business Mailing Address
First Line	:	8025 CORPORATE CENTER DR STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4544
Country	:	US
Telephone Number	:	704-541-1191
Fax Number	:	704-541-1192

Provider Business Practice Location Address
First Line	:	8025 CORPORATE CENTER DR STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4544
Country	:	US
Telephone Number	:	704-541-1191
Fax Number	:	704-541-1192

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

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	03/27/2024

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