Provider Demographics
NPI:1740627462
Name:WILLIAMS, MICHAEL S (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
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 1:525 W 5300 S STE 150
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5684
Mailing Address - Country:US
Mailing Address - Phone:801-263-0530
Mailing Address - Fax:801-281-5583
Practice Address - Street 1:525 W 5300 S STE 150
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-5684
Practice Address - Country:US
Practice Address - Phone:801-263-0530
Practice Address - Fax:801-281-5583
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8541378-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist