Provider Demographics
NPI:1538033642
Name:WILLIAMS, JILLIAN LORAINE
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:LORAINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9058 SHREVEPORT HWY
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-1812
Mailing Address - Country:US
Mailing Address - Phone:337-239-3460
Mailing Address - Fax:337-239-3462
Practice Address - Street 1:9058 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-1812
Practice Address - Country:US
Practice Address - Phone:337-239-3460
Practice Address - Fax:337-239-3462
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACP049470T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist