Provider Demographics
NPI:1386931400
Name:WILLIAMS, ERIC ALAN (LMT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ALAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4942
Mailing Address - Country:US
Mailing Address - Phone:304-673-1820
Mailing Address - Fax:
Practice Address - Street 1:1104 JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4942
Practice Address - Country:US
Practice Address - Phone:304-673-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-10
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2011-2861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist