Healthcare Provider Details

I. General information

NPI: 1699256917
Provider Name (Legal Business Name): WILLIAM PAUL GUSMUS II LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EUREKA ST STE A
BATESVILLE MS
38606-2534
US

IV. Provider business mailing address

50 S MAIN ST
WATER VALLEY MS
38965-2946
US

V. Phone/Fax

Practice location:
  • Phone: 662-578-7799
  • Fax: 662-578-7992
Mailing address:
  • Phone: 662-473-4777
  • Fax: 662-473-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5779
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: