Basic Information
Provider Information
NPI: 1396229878
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: KATHERINE
MiddleName: LEIGH
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 523 GRAND ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100024103
CountryCode: US
TelephoneNumber: 8043822826
FaxNumber:  
Practice Location
Address1: 525 E 68TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100654870
CountryCode: US
TelephoneNumber: 2127461500
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/20/2018
LastUpdateDate: 09/20/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X043517NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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