Provider Demographics
NPI:1790848893
Name:THREADGILL, WILLIAM (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:THREADGILL
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5907 84TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3609
Mailing Address - Country:US
Mailing Address - Phone:806-783-8234
Mailing Address - Fax:806-783-8235
Practice Address - Street 1:4010 82ND ST
Practice Address - Street 2:SUITE 130
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1949
Practice Address - Country:US
Practice Address - Phone:806-783-8234
Practice Address - Fax:806-783-8235
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10635762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4088OtherBLUECROSSBLUESHIELD INDIV
TX8E0071Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL