Provider Demographics
NPI:1821984238
Name:WILLIAMSON, MANDY
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 KINGS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-9266
Mailing Address - Country:US
Mailing Address - Phone:218-230-0853
Mailing Address - Fax:
Practice Address - Street 1:749 S 30TH ST APT 23
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4082
Practice Address - Country:US
Practice Address - Phone:218-230-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist