MEDICARE: WILLIAM P. SORRELS 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	174400000X	Specialist	2351	NC
2	225100000X	Physical Therapist	2351	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	078MC	OTHER	NC	BCBS
3	562280901	OTHER	NC	TAX ID #

General Provider Information

NPI Number	:	1710938824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM P. SORRELS PT

Provider Business Mailing Address
First Line	:	1811 FOREST HILLS RD W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3412
Country	:	US
Telephone Number	:	252-243-7400
Fax Number	:	252-243-3291

Provider Business Practice Location Address
First Line	:	1811 FOREST HILLS RD W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3412
Country	:	US
Telephone Number	:	252-243-7400
Fax Number	:	252-243-3291

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

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	06/18/2013

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