Provider Demographics
NPI:1336389543
Name:WILLIAMS, AMANDA LEE (PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 JOYCE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-2634
Mailing Address - Country:US
Mailing Address - Phone:832-260-8993
Mailing Address - Fax:832-426-0299
Practice Address - Street 1:520 BIRDSONG DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2548
Practice Address - Country:US
Practice Address - Phone:832-260-8993
Practice Address - Fax:832-426-0299
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist