Provider Demographics
NPI:1912880485
Name:WILLIAMS, JAN (DPT)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:VAN TWISK
Other - Last Name:BEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7849 TRAMWAY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2529
Mailing Address - Country:US
Mailing Address - Phone:505-485-4176
Mailing Address - Fax:505-212-0786
Practice Address - Street 1:8010 PALOMAS AVE NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5201
Practice Address - Country:US
Practice Address - Phone:505-208-7551
Practice Address - Fax:505-212-3867
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT4888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist