Provider Demographics
NPI:1467992438
Name:ROE, WILLIAM (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:ROE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OAKS DR
Mailing Address - Street 2:APT 402
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6996
Mailing Address - Country:US
Mailing Address - Phone:567-230-3138
Mailing Address - Fax:
Practice Address - Street 1:608 13TH ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35228-2430
Practice Address - Country:US
Practice Address - Phone:205-934-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer