Provider Demographics
NPI:1194123802
Name:VAN WILLIAMS PHYSICAL THERAPY
Entity type:Organization
Organization Name:VAN WILLIAMS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:530-945-7294
Mailing Address - Street 1:1988 PARK MARINA DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0912
Mailing Address - Country:US
Mailing Address - Phone:530-241-1559
Mailing Address - Fax:530-241-4298
Practice Address - Street 1:1988 PARK MARINA DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0912
Practice Address - Country:US
Practice Address - Phone:530-241-1559
Practice Address - Fax:530-241-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty