Provider Demographics
NPI:1558046797
Name:MCILWAIN, WILLIAM (LMT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MCILWAIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 S MILL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2560
Mailing Address - Country:US
Mailing Address - Phone:859-231-1782
Mailing Address - Fax:859-813-5027
Practice Address - Street 1:380 S MILL ST STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2560
Practice Address - Country:US
Practice Address - Phone:859-231-1782
Practice Address - Fax:859-813-5027
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165181225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist