Elawnto Reggie Williams, MBA, PTA, CSCS

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA19797 Issued in FL

Practice address

4469 Mobile Hwy Ste C
Pensacola, FL 32506-7100

Phone

(850) 458-2020

NPI assigned

Jan 25, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Business Administration

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legendary Physical Therapy LLC

  • Physical Therapist
  • Pensacola, FL
  • NPI 1578089983
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1225215916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2059 JUNO CIR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325268422",
            "telephone_number": "850-291-4523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4469 MOBILE HWY STE C",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325067100",
            "telephone_number": "850-458-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "ELAWNTO",
        "middle_name": "REGGIE",
        "name_prefix": "Mr.",
        "credential": "MBA, PTA, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-25",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA19797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devon Allan Williams
• Donna G Williams, ARNP
• Doveline Handell Williams, RN/BSN
• Edna Williams, LMHC
• Ekeidra Keshawndra Williams
• Erin K Williams, AUD
• Gail Leverne Williams
• Heather Dawn Williams, BCBA
• James B Williams, M.D.
• Jasmin D Williams

• Physical Therapy Assistant in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.