Provider Demographics
NPI:1043677164
Name:WILLIAMS, MICHAEL (ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 OLD MAIN HL
Mailing Address - Street 2:UTAH STATE UNIVERSITY
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-7425
Mailing Address - Country:US
Mailing Address - Phone:435-797-3636
Mailing Address - Fax:435-797-3828
Practice Address - Street 1:7425 OLD MAIN HL
Practice Address - Street 2:UTAH STATE UNIVERSITY
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-7425
Practice Address - Country:US
Practice Address - Phone:435-797-3636
Practice Address - Fax:435-797-3828
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6336751-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer