Provider Demographics
NPI:1225707599
Name:WILLIAMS, JEFFERY DALE
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:DALE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 N 130 E
Mailing Address - Street 2:
Mailing Address - City:VINEYARD
Mailing Address - State:UT
Mailing Address - Zip Code:84059-6565
Mailing Address - Country:US
Mailing Address - Phone:801-228-8968
Mailing Address - Fax:
Practice Address - Street 1:1735 S REDWOOD RD STE 115
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-5107
Practice Address - Country:US
Practice Address - Phone:801-973-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy