Provider Demographics
NPI:1962912550
Name:WILLIAMSON, KELLY MARIE (PT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:WILLIAMSON
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 1:54 MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-3622
Mailing Address - Country:US
Mailing Address - Phone:508-544-1540
Mailing Address - Fax:508-544-1541
Practice Address - Street 1:1 LUMBER ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-2363
Practice Address - Country:US
Practice Address - Phone:508-544-1540
Practice Address - Fax:508-544-1541
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist