Provider Demographics
NPI:1629313465
Name:WILLIAMS, NICHOLAS J (ATC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
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 1:900 ROUND VALLEY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7552
Mailing Address - Country:US
Mailing Address - Phone:435-655-6600
Mailing Address - Fax:435-655-2388
Practice Address - Street 1:900 ROUND VALLEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7552
Practice Address - Country:US
Practice Address - Phone:435-655-6600
Practice Address - Fax:435-655-2388
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8455635-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer