Provider Demographics
NPI:1275826687
Name:WILLIAMS, SCOTT ADAM (CMT, CPT, CNC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ADAM
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CMT, CPT, CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19106 E LOW DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3192
Mailing Address - Country:US
Mailing Address - Phone:303-981-5850
Mailing Address - Fax:
Practice Address - Street 1:2440 KENDALL ST
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:CO
Practice Address - Zip Code:80214-1046
Practice Address - Country:US
Practice Address - Phone:303-981-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
74-3115520OtherNOT APPLICABLE