Provider Demographics
NPI:1891743530
Name:WILLIAMS, REAGAN LESLIE (PT)
Entity type:Individual
Prefix:MRS
First Name:REAGAN
Middle Name:LESLIE
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 1:96 MACON CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-6779
Mailing Address - Country:US
Mailing Address - Phone:828-369-9103
Mailing Address - Fax:828-369-9659
Practice Address - Street 1:96 MACON CENTER DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-6779
Practice Address - Country:US
Practice Address - Phone:828-369-9103
Practice Address - Fax:828-369-9659
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079W6OtherBC PROVIDER #