Provider Demographics
NPI:1316176100
Name:WILLIAMS, LAURA B (DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535N LOCUST GROVE RD 170
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9379
Mailing Address - Country:US
Mailing Address - Phone:208-917-2660
Mailing Address - Fax:208-917-2630
Practice Address - Street 1:535 N LOCUST GROVE RD
Practice Address - Street 2:SUITE #170
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9020
Practice Address - Country:US
Practice Address - Phone:208-917-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1284225100000X
ID2872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist