MEDICARE: MR. WILLIAM FRANCIS DESSOYE III MSPT

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	PT015702	PA

General Provider Information

NPI Number	:	1801077821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM FRANCIS DESSOYE III MSPT

Provider Business Mailing Address
First Line	:	50 MOISEY DR
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18202-9297
Country	:	US
Telephone Number	:	570-501-6767
Fax Number	:	570-501-6769

Provider Business Practice Location Address
First Line	:	50 MOISEY DR
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18202-9297
Country	:	US
Telephone Number	:	570-501-6767
Fax Number	:	570-501-6769

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

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	11/19/2007

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