Provider Demographics
NPI:1073543591
Name:EVERETT, WILLIAM ROBERT (LATC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:EVERETT
Suffix:
Gender:M
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1314
Mailing Address - Country:US
Mailing Address - Phone:617-283-2892
Mailing Address - Fax:
Practice Address - Street 1:785 CENTRE ST
Practice Address - Street 2:NEWTON COUNTRY DAY SCHOOL
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2523
Practice Address - Country:US
Practice Address - Phone:617-559-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer