Provider Demographics
NPI:1316910003
Name:WILLIAMS, MATTHEA SHERRELL (LAT, ATC)
Entity type:Individual
Prefix:
First Name:MATTHEA
Middle Name:SHERRELL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:MATTHEA
Other - Middle Name:SHERRELL
Other - Last Name:HUNGERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1312 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76798-0009
Mailing Address - Country:US
Mailing Address - Phone:254-710-4024
Mailing Address - Fax:
Practice Address - Street 1:1312 S 5TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76798-0009
Practice Address - Country:US
Practice Address - Phone:254-710-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT52892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer