Provider Demographics
NPI:1306336110
Name:WILLIAMS, BLAIR THOMAS (PT)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:THOMAS
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-0421
Mailing Address - Country:US
Mailing Address - Phone:325-277-9193
Mailing Address - Fax:
Practice Address - Street 1:2001 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-2500
Practice Address - Country:US
Practice Address - Phone:325-365-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist