Provider Demographics
NPI:1659580553
Name:NEWSOM, WILLIAM
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:NEWSOM
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BILLY
Other - Middle Name:
Other - Last Name:NEWSOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATHLETIC TRAINER
Mailing Address - Street 1:29 ROBINHOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-2127
Mailing Address - Country:US
Mailing Address - Phone:940-683-5216
Mailing Address - Fax:
Practice Address - Street 1:1 MAROON DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-6741
Practice Address - Country:US
Practice Address - Phone:940-683-4066
Practice Address - Fax:940-683-4066
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATO 8802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer