Provider Demographics
NPI:1689925158
Name:BOURNE, WILLIAM F (PTA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:F
Last Name:BOURNE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SAXON DR
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-2765
Mailing Address - Country:US
Mailing Address - Phone:513-255-2346
Mailing Address - Fax:
Practice Address - Street 1:2401 S L ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-7439
Practice Address - Country:US
Practice Address - Phone:765-966-5705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002535A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant