Provider Demographics
NPI:1487964482
Name:WILLIAMS, LADD RYAN (PT)
Entity type:Individual
Prefix:MR
First Name:LADD
Middle Name:RYAN
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 1:11890 DONNER PASS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0448
Mailing Address - Country:US
Mailing Address - Phone:530-582-8609
Mailing Address - Fax:
Practice Address - Street 1:11890 DONNER PASS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0448
Practice Address - Country:US
Practice Address - Phone:530-582-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-12
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic