Healthcare Provider Details

I. General information

NPI: 1386329365
Provider Name (Legal Business Name): JEFFERY D WILLIAMS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1352 LOWER ELMORE MOUNTAIN RD
MORRISTOWN VT
05661-8062
US

IV. Provider business mailing address

105 DEPOT ST UNIT 841
STOWE VT
05672-7434
US

V. Phone/Fax

Practice location:
  • Phone: 802-760-8494
  • Fax:
Mailing address:
  • Phone: 802-760-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number164.0000709
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: