Provider Demographics
NPI:1053779306
Name:WILLIAMS, STEPHEN CARK (MPT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CARK
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 1:440 LUTHER BANKS RD
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-7272
Mailing Address - Country:US
Mailing Address - Phone:910-324-3250
Mailing Address - Fax:
Practice Address - Street 1:7011 GUM BRANCH RD
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28574-8227
Practice Address - Country:US
Practice Address - Phone:910-430-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP7940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist