Provider Demographics
NPI:1952899924
Name:WILLIAMSON, BONNIE (MPT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11894 S HIDDEN CANYON LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-6804
Mailing Address - Country:US
Mailing Address - Phone:801-718-2294
Mailing Address - Fax:
Practice Address - Street 1:7940 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-0744
Practice Address - Country:US
Practice Address - Phone:801-386-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT283491-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist