Provider Demographics
NPI:1649270471
Name:MCCORMICK, WILLIAM J (MS, PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MS, PT
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Mailing Address - Street 1:3903 NORTHDALE BLVD STE 111W
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1853
Mailing Address - Country:US
Mailing Address - Phone:813-381-6778
Mailing Address - Fax:440-815-2120
Practice Address - Street 1:1056 E BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5509
Practice Address - Country:US
Practice Address - Phone:813-413-5513
Practice Address - Fax:813-681-8300
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2016-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEPT1390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME038814OtherBC/BS OF MAINE
MEMM7219Medicare ID - Type Unspecified