Healthcare Provider Details

I. General information

NPI: 1184895542
Provider Name (Legal Business Name): WILLIAMS AND WILLIAMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 HOLLYANN CT
TWIN FALLS ID
83301-3418
US

IV. Provider business mailing address

PO BOX 1886
TWIN FALLS ID
83303-1886
US

V. Phone/Fax

Practice location:
  • Phone: 208-735-8330
  • Fax: 208-735-8564
Mailing address:
  • Phone: 208-736-0887
  • Fax: 208-736-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-1026
License Number StateID

VIII. Authorized Official

Name: BRADLEY C WILLIAMS
Title or Position: MANAGING MEMBER
Credential: RPT
Phone: 208-735-8330