Provider Demographics
NPI:1477002798
Name:BRUMMETT, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BRUMMETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BILLY
Other - Middle Name:
Other - Last Name:BRUMMETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:308 W MEADOWVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-3610
Mailing Address - Country:US
Mailing Address - Phone:336-378-0486
Mailing Address - Fax:
Practice Address - Street 1:308 W MEADOWVIEW RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-3610
Practice Address - Country:US
Practice Address - Phone:336-378-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4014225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant