Provider Demographics
NPI:1356507685
Name:NORTHERN, WILLIAM (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:NORTHERN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CAHABA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-5106
Mailing Address - Country:US
Mailing Address - Phone:205-661-3611
Mailing Address - Fax:
Practice Address - Street 1:5890 VALLEY RD STE 105
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-8669
Practice Address - Country:US
Practice Address - Phone:205-661-9884
Practice Address - Fax:205-661-9743
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist