Provider Demographics
NPI:1881127660
Name:PASSMAN, WILLIAM EARL JR (LMT, MMP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EARL
Last Name:PASSMAN
Suffix:JR
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 S MAGNOLIA ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5020
Mailing Address - Country:US
Mailing Address - Phone:985-662-0991
Mailing Address - Fax:985-662-0976
Practice Address - Street 1:1402 S MAGNOLIA ST
Practice Address - Street 2:SUITE D
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5020
Practice Address - Country:US
Practice Address - Phone:985-662-0991
Practice Address - Fax:985-662-0976
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA8187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist