Provider Demographics
NPI:1417948068
Name:COCHRAN, WILLIAM T JR (RPT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:T
Last Name:COCHRAN
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6068 HIGHWAY 98
Mailing Address - Street 2:SUITE 1196
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8861
Mailing Address - Country:US
Mailing Address - Phone:601-296-0199
Mailing Address - Fax:601-296-0189
Practice Address - Street 1:52 98 PLACE BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8063
Practice Address - Country:US
Practice Address - Phone:601-296-0199
Practice Address - Fax:601-296-0189
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08589350Medicaid
MSP03496Medicare UPIN
MS650000242Medicare ID - Type Unspecified