Healthcare Provider Details

I. General information

NPI: 1225095177
Provider Name (Legal Business Name): WILLIAM EDWARD NEVILLE MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 VENTURE CT
COLUMBUS OH
43228-9600
US

IV. Provider business mailing address

7582 GORDON CIR
COLUMBUS OH
43235-1913
US

V. Phone/Fax

Practice location:
  • Phone: 614-771-5545
  • Fax:
Mailing address:
  • Phone: 614-734-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001714
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: