1528312592 NPI number — JENNIFER FAITH WILLIAMS MS, ATC

Table of content: JENNIFER FAITH WILLIAMS MS, ATC (NPI 1528312592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528312592 NPI number — JENNIFER FAITH WILLIAMS MS, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
JENNIFER
Provider Middle Name:
FAITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RYAN
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
FAITH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528312592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 CAMPUS BLVD
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-2872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-667-9252
Provider Business Mailing Address Fax Number:
540-722-4514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 CAMPUS BLVD
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601-2872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-667-9252
Provider Business Practice Location Address Fax Number:
540-722-4514
Provider Enumeration Date:
10/30/2012

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: 207X00000X , with the licence number:  0126001623 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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