MEDICARE: COREY TRAYNOR WILLIAMS MPT

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	PT00009037	WA

General Provider Information

NPI Number	:	1841253655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY TRAYNOR WILLIAMS MPT

Provider Business Mailing Address
First Line	:	1043 NE 95TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2217
Country	:	US
Telephone Number	:	425-876-8653
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 E 1ST ST
Second Line	:
City	:	CLE ELUM
State	:	WA
Zip	:	98922-1252
Country	:	US
Telephone Number	:	425-876-8653
Fax Number	:

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/21/2022

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