Healthcare Provider Details

I. General information

NPI: 1104819655
Provider Name (Legal Business Name): JASON G WILLIAMS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 S 400 W
SPANISH FORK UT
84660-2053
US

IV. Provider business mailing address

77 S 400 W
SPANISH FORK UT
84660-2053
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-1626
  • Fax: 801-798-1236
Mailing address:
  • Phone: 801-798-1626
  • Fax: 801-798-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number59325932401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: