Healthcare Provider Details

I. General information

NPI: 1639793953
Provider Name (Legal Business Name): TAYLOR N WILLIAMS DPT LICENSE: PT-6769
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 E PLAZA DR
EAGLE ID
83616-6548
US

IV. Provider business mailing address

875 E PLAZA DR STE 103
EAGLE ID
83616-6549
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-0886
  • Fax: 208-939-1131
Mailing address:
  • Phone: 208-939-0886
  • Fax: 208-939-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-6769
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-6769
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: