Provider Demographics
NPI:1326756966
Name:GANT, WILLIAM CODY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CODY
Last Name:GANT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 ENVOY CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1822
Mailing Address - Country:US
Mailing Address - Phone:502-244-6770
Mailing Address - Fax:
Practice Address - Street 1:1700 ENVOY CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1822
Practice Address - Country:US
Practice Address - Phone:502-244-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist