Provider Demographics
NPI:1679546964
Name:GATTI, WILLIAM BANNON (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BANNON
Last Name:GATTI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-0589
Mailing Address - Country:US
Mailing Address - Phone:828-246-2233
Mailing Address - Fax:
Practice Address - Street 1:5087 HWY 17 N BYPASS
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-902-2120
Practice Address - Fax:843-405-0148
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP2975225100000X
SC5828225100000X
FLPT29040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC250211Medicare ID - Type Unspecified