Provider Demographics
NPI:1154346492
Name:WILLIAMS, ANGUS JONOTHAN (PT)
Entity type:Individual
Prefix:
First Name:ANGUS
Middle Name:JONOTHAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7285
Mailing Address - Country:US
Mailing Address - Phone:615-416-0199
Mailing Address - Fax:
Practice Address - Street 1:6661 DIXIE HWY STE 8
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3950
Practice Address - Country:US
Practice Address - Phone:502-216-1628
Practice Address - Fax:502-333-9202
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F360770OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI650F360770OtherBLUE CROSS BLUE SHIELD OF MICHIGAN