Provider Demographics
NPI:1366560153
Name:WILLIAMS, WILLIAM KENNETH JR (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KENNETH
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:104 HONEYSUCKLE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72132-9370
Mailing Address - Country:US
Mailing Address - Phone:501-397-7698
Mailing Address - Fax:501-397-7698
Practice Address - Street 1:104 HONEYSUCKLE HILLS DR
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:AR
Practice Address - Zip Code:72132-9370
Practice Address - Country:US
Practice Address - Phone:501-397-7698
Practice Address - Fax:501-397-7698
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPT12452251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S345OtherBCBS PHYSICAL THERAPIST
AR5S345Medicare ID - Type UnspecifiedPHYSICAL THERAPIST