MEDICARE: WILLIAM J MCCORMICK MS, PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT1390	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	038814	OTHER	ME	BC/BS OF MAINE

General Provider Information

NPI Number	:	1649270471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM J MCCORMICK MS, PT

Provider Business Mailing Address
First Line	:	3903 NORTHDALE BLVD STE 111W
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1853
Country	:	US
Telephone Number	:	813-381-6778
Fax Number	:	440-815-2120

Provider Business Practice Location Address
First Line	:	1056 E BRANDON BLVD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5509
Country	:	US
Telephone Number	:	813-413-5513
Fax Number	:	813-681-8300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	04/04/2016

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