MEDICARE: BONNIE WILLIAMSON 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	283491-2401	UT

General Provider Information

NPI Number	:	1952899924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE WILLIAMSON MPT

Provider Business Mailing Address
First Line	:	11894 S HIDDEN CANYON LN
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-6804
Country	:	US
Telephone Number	:	801-718-2294
Fax Number	:

Provider Business Practice Location Address
First Line	:	7940 S 1300 E
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-0744
Country	:	US
Telephone Number	:	801-386-6722
Fax Number	:

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

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	04/25/2018

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