Basic Information
| Provider Information | |||||||||
| NPI: | 1114476264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMSON | ||||||||
| FirstName: | CELESTE | ||||||||
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| Credential: | BSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1524 LIVINGSTON VERNON RD | ||||||||
| Address2: | |||||||||
| City: | FLORA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390719516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018798518 | ||||||||
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| Practice Location | |||||||||
| Address1: | 746 E FIFTEENTH ST | ||||||||
| Address2: | |||||||||
| City: | YAZOO CITY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391942706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627464032 | ||||||||
| FaxNumber: | 6017460967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2016 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT887 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.