Provider Demographics
NPI:1386873305
Name:WILLIAMS, TYLER (DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 PIEDMONT AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4766
Mailing Address - Country:US
Mailing Address - Phone:208-921-3372
Mailing Address - Fax:
Practice Address - Street 1:4341 PIEDMONT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4766
Practice Address - Country:US
Practice Address - Phone:208-921-3372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-12
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist