Provider Demographics
NPI:1922556182
Name:TRUJILLO, WILLIAM BRETT
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRETT
Last Name:TRUJILLO
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 1:500 N BULLARD AVE
Mailing Address - Street 2:C27
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2533
Mailing Address - Country:US
Mailing Address - Phone:623-986-5110
Mailing Address - Fax:
Practice Address - Street 1:500 N BULLARD AVE
Practice Address - Street 2:C27
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2533
Practice Address - Country:US
Practice Address - Phone:623-986-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10218PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist