Provider Demographics
NPI:1871719716
Name:WILLIAMS, VAN CHARLES (MPT)
Entity type:Individual
Prefix:
First Name:VAN
Middle Name:CHARLES
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 VICTOR AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002
Mailing Address - Country:US
Mailing Address - Phone:530-221-1312
Mailing Address - Fax:530-221-4291
Practice Address - Street 1:3075 VICTOR AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002
Practice Address - Country:US
Practice Address - Phone:530-221-1312
Practice Address - Fax:530-221-4291
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist