Provider Demographics
NPI:1780652529
Name:MAYNARD, WILLIAM LEE JR (PT MS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LEE
Last Name:MAYNARD
Suffix:JR
Gender:M
Credentials:PT MS
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Mailing Address - Street 1:1208 S FM 51
Mailing Address - Street 2:SUITE B
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-2408
Mailing Address - Country:US
Mailing Address - Phone:940-627-7554
Mailing Address - Fax:940-627-7582
Practice Address - Street 1:1208 S FM 51
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-2408
Practice Address - Country:US
Practice Address - Phone:940-627-7554
Practice Address - Fax:940-627-7582
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-05-28
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Provider Licenses
StateLicense IDTaxonomies
TX1150877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist