Provider Demographics
NPI:1215170139
Name:WILLIAMS, MARY LOU (MS/RPT)
Entity type:Individual
Prefix:MS
First Name:MARY LOU
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS/RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PIONEER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9501
Mailing Address - Country:US
Mailing Address - Phone:570-262-9836
Mailing Address - Fax:
Practice Address - Street 1:5 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9501
Practice Address - Country:US
Practice Address - Phone:570-262-9836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000911E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist