Provider Demographics
NPI:1902293095
Name:WILLIAMS, ROBERT J (LMT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 SIDNEY ST
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-1267
Mailing Address - Country:US
Mailing Address - Phone:734-770-7960
Mailing Address - Fax:
Practice Address - Street 1:238 SIDNEY ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-1267
Practice Address - Country:US
Practice Address - Phone:734-770-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501001004225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist