Provider Demographics
NPI:1285063065
Name:WILLIAMS, BEVERLY NATAUSHA
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:NATAUSHA
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 1:3101 N CENTRAL AVE STE 171
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3611
Mailing Address - Country:US
Mailing Address - Phone:702-601-2697
Mailing Address - Fax:
Practice Address - Street 1:3101 N CENTRAL AVE STE 171
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3611
Practice Address - Country:US
Practice Address - Phone:702-601-2697
Practice Address - Fax:602-801-2800
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner