Individual
JUSTIN K WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
10128 W BROAD ST, FORUM BUILDING III, SUITE K, GLEN ALLEN, VA 23060-6761
(804) 217-9210
(804) 217-9213
Mailing address
771 PILOT HOUSE DR, SUITE A, NEWPORT NEWS, VA 23606-1990
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305207727
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851645543
MEDICAID QMB
VA
01
—
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
11/01/2012
Last updated
11/07/2014
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