Provider Demographics
NPI:1699886424
Name:WILLIAMS, LINDA A (PT)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-2038
Mailing Address - Country:US
Mailing Address - Phone:201-796-5273
Mailing Address - Fax:201-796-8645
Practice Address - Street 1:511 BOULEVARD
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-2038
Practice Address - Country:US
Practice Address - Phone:201-796-5273
Practice Address - Fax:201-796-8645
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00125100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ106470Medicare PIN