MEDICARE: MR. BRYAN ELLIOT WILLIAMS MSPT

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	24253	CA

General Provider Information

NPI Number	:	1851372874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN ELLIOT WILLIAMS MSPT

Provider Business Mailing Address
First Line	:	PO BOX 162097
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-2097
Country	:	US
Telephone Number	:	916-439-7829
Fax Number	:

Provider Business Practice Location Address
First Line	:	648 NORTHFIELD DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-2442
Country	:	US
Telephone Number	:	916-439-7829
Fax Number	:

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

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

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