Provider Demographics
NPI:1275562654
Name:PRINCE, WILLIAM CHAD (MSPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHAD
Last Name:PRINCE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1765
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-1765
Mailing Address - Country:US
Mailing Address - Phone:256-236-4121
Mailing Address - Fax:256-237-5254
Practice Address - Street 1:731 LEIGHTON AVE. SUITE. 405
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207
Practice Address - Country:US
Practice Address - Phone:256-236-4121
Practice Address - Fax:256-237-5254
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I650019OtherMEDICARE PTAN
AL0515-44793OtherBCBS OF AL
AL0515-44793OtherBCBS OF AL