Provider Demographics
NPI:1801678651
Name:WILLIAMS, ROBERT CECIL (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CECIL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 RANCHO CORRALITOS RD
Mailing Address - Street 2:
Mailing Address - City:CORRALITOS
Mailing Address - State:CA
Mailing Address - Zip Code:95076-1139
Mailing Address - Country:US
Mailing Address - Phone:831-234-6968
Mailing Address - Fax:
Practice Address - Street 1:129 RANCHO CORRALITOS RD
Practice Address - Street 2:
Practice Address - City:CORRALITOS
Practice Address - State:CA
Practice Address - Zip Code:95076-1139
Practice Address - Country:US
Practice Address - Phone:831-234-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist