Provider Demographics
NPI:1841230539
Name:GANDY, WILLIAM M (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:GANDY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 LAMAR AVENUE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462
Mailing Address - Country:US
Mailing Address - Phone:903-785-3861
Mailing Address - Fax:903-739-8768
Practice Address - Street 1:4005 LAMAR AVENUE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462
Practice Address - Country:US
Practice Address - Phone:903-785-3861
Practice Address - Fax:903-739-8768
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1052538225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100835750AMedicaid
120494OtherSUPERIOR PROVIDER NUMBER
7445440OtherAETNA PROVIDER NUMBER
TX80815TOtherBCBS PROVIDER NUMBER
TX058543201Medicaid