Provider Demographics
NPI:1033129416
Name:ANDERSON, WILLIAM DAVID JR (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DAVID
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-8819
Mailing Address - Country:US
Mailing Address - Phone:972-412-2987
Mailing Address - Fax:
Practice Address - Street 1:1100 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3204
Practice Address - Country:US
Practice Address - Phone:903-983-8628
Practice Address - Fax:903-988-7445
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT27462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer