Provider Demographics
NPI: | 1457375560 |
---|---|
Name: | MEGGINSON, WILLIAM JAY (PT) |
Entity Type: | Individual |
Prefix: | |
First Name: | WILLIAM |
Middle Name: | JAY |
Last Name: | MEGGINSON |
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: | 7048 JEWETT STREET |
Mailing Address - Street 2: | P.O. BOX 866 |
Mailing Address - City: | MONTROSE |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 36559 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 251-929-3646 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7048 JEWETT STREET |
Practice Address - Street 2: | |
Practice Address - City: | MONTROSE |
Practice Address - State: | AL |
Practice Address - Zip Code: | 36559-0866 |
Practice Address - Country: | US |
Practice Address - Phone: | 251-929-3646 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-26 |
Last Update Date: | 2022-11-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AL | PTH3138 | 174400000X |
225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AL | 510-02125 | Other | BCBS |
AL | 890013700 | Medicaid | |
AL | 510-02125 | Other | BCBS |
AL | 510I650146 | Medicare PIN |