Provider Demographics
NPI:1841215837
Name:KLOSE, WILLIAM MICHAEL JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:KLOSE
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:2903 UNRUH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2527
Mailing Address - Country:US
Mailing Address - Phone:215-332-1953
Mailing Address - Fax:215-884-1713
Practice Address - Street 1:201 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3707
Practice Address - Country:US
Practice Address - Phone:215-884-9050
Practice Address - Fax:215-884-1713
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PART0034892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer