Provider Demographics
NPI:1376854349
Name:WILLIAMS, STEPHANIE LEE (PTA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 SHADY BROOK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3993
Mailing Address - Country:US
Mailing Address - Phone:931-388-8500
Mailing Address - Fax:931-388-8526
Practice Address - Street 1:1810 SHADY BROOK ST STE 3
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3993
Practice Address - Country:US
Practice Address - Phone:931-388-8500
Practice Address - Fax:931-388-8526
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA4284225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant