Provider Demographics
NPI:1972660405
Name:COKER, WILLIAM BENJAMIN (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:COKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:COKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:206B OXFORD RD
Mailing Address - Street 2:PO BOX 44
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3115
Mailing Address - Country:US
Mailing Address - Phone:662-534-4445
Mailing Address - Fax:662-534-9449
Practice Address - Street 1:206B OXFORD RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3115
Practice Address - Country:US
Practice Address - Phone:662-534-4445
Practice Address - Fax:662-534-9449
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04471091Medicaid
MS582681044OtherTAX ID #
MS256599Medicare ID - Type UnspecifiedMEDICARE ID