1326296971 NPI number — MRS. TEREA S WILLIAMSON DPT, ATC

Table of content: MRS. TEREA S WILLIAMSON DPT, ATC (NPI 1326296971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326296971 NPI number — MRS. TEREA S WILLIAMSON DPT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMSON
Provider First Name:
TEREA
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RHODES
Provider Other First Name:
TEREA
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT, ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326296971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 PENNSYLVANIA PKWY
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46280-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-817-1200
Provider Business Mailing Address Fax Number:
317-208-1551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 PENNSYLVANIA PKW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46280-1393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-817-1200
Provider Business Practice Location Address Fax Number:
317-867-1220
Provider Enumeration Date:
09/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  05009100A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2255A2300X , with the licence number: 36001001A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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