Provider Demographics
NPI:1043042294
Name:WILLIAMS, ROXANNE (MT)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 HILL AVE # 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-1934
Mailing Address - Country:US
Mailing Address - Phone:412-403-4751
Mailing Address - Fax:
Practice Address - Street 1:1360 OLD FREEPORT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-4102
Practice Address - Country:US
Practice Address - Phone:412-772-1461
Practice Address - Fax:412-756-8451
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG001648225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist