Provider Demographics
NPI:1104819655
Name:WILLIAMS, JASON G (DPT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 S 400 W
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-2053
Mailing Address - Country:US
Mailing Address - Phone:801-798-1626
Mailing Address - Fax:801-798-1236
Practice Address - Street 1:77 S 400 W
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2053
Practice Address - Country:US
Practice Address - Phone:801-798-1626
Practice Address - Fax:801-798-1236
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59325932401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1629259189OtherAETNA
UT1629259189OtherTRICARE
1629259189OtherUNITED HEALTHCARE
UTQM0000076331OtherALTIUS
UT870578539003Medicaid
UTQM0000076331OtherALTIUS