Basic Information
| Provider Information | |||||||||
| NPI: | 1144340035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | ERIN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 ALYSSUM PL | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271277548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367828123 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4410 PROVIDENCE LN | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271063254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368969999 | ||||||||
| FaxNumber: | 3367592020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11012 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.