Provider Demographics
NPI:1386989101
Name:WILLIAMS, ROBERT A (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
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 1:555 LUTHER RD
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-4256
Mailing Address - Country:US
Mailing Address - Phone:530-527-6232
Mailing Address - Fax:530-528-1680
Practice Address - Street 1:555 LUTHER RD
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4256
Practice Address - Country:US
Practice Address - Phone:530-527-6232
Practice Address - Fax:530-528-1680
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 27043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist