Provider Demographics
NPI:1447954870
Name:WILLIAMS, TAYLOR JANAE (LMBT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JANAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23335 ANGELICO RD
Mailing Address - Street 2:
Mailing Address - City:CAPRON
Mailing Address - State:VA
Mailing Address - Zip Code:23829-2431
Mailing Address - Country:US
Mailing Address - Phone:984-297-3435
Mailing Address - Fax:
Practice Address - Street 1:1353 ARMORY DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-2419
Practice Address - Country:US
Practice Address - Phone:984-297-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19491225700000X
VA0091018709225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist