Provider Demographics
NPI:1225548076
Name:WILLIAMS, MARY K
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-1758
Mailing Address - Country:US
Mailing Address - Phone:410-838-6808
Mailing Address - Fax:410-838-2511
Practice Address - Street 1:12 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-1758
Practice Address - Country:US
Practice Address - Phone:410-838-6808
Practice Address - Fax:410-838-2511
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist