MEDICARE: GABRIEL JACOB WILLIAMS PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTLP.0000262	CO

General Provider Information

NPI Number	:	1679200927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL JACOB WILLIAMS PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 775968
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477-5968
Country	:	US
Telephone Number	:	510-508-7492
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 MARKETPLACE PLZ UNIT B5
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-1804
Country	:	US
Telephone Number	:	970-819-6252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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