Provider Demographics
NPI:1821265489
Name:MARCONI, WILLIAM SRIMUANG
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SRIMUANG
Last Name:MARCONI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E WINDHORST RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2524
Mailing Address - Country:US
Mailing Address - Phone:813-685-2399
Mailing Address - Fax:
Practice Address - Street 1:110 E WINDHORST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2524
Practice Address - Country:US
Practice Address - Phone:813-685-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246Y00000X
NCTMB 298479-00225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist