Provider Demographics
NPI:1649202334
Name:WILLIAMS, JERRY L (PT)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:2300 WESTERN AVE
Mailing Address - Street 2:PO BOX 2170
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-3712
Mailing Address - Country:US
Mailing Address - Phone:920-320-8667
Mailing Address - Fax:920-320-8616
Practice Address - Street 1:600 YORK ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6845
Practice Address - Country:US
Practice Address - Phone:920-320-6750
Practice Address - Fax:920-682-1981
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1517-0242251P0200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI719078OtherT19 MANAGED HEALTH SERVIC
WI40132800Medicaid