Provider Demographics
NPI:1679915581
Name:WILLIAMS, MINDY MARIE (LMT, CMT)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2320
Mailing Address - Country:US
Mailing Address - Phone:951-316-1251
Mailing Address - Fax:
Practice Address - Street 1:2395 HAMNER AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2674
Practice Address - Country:US
Practice Address - Phone:951-736-8079
Practice Address - Fax:951-736-9695
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37910172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist