=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912426685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM JORDAN HOWELL PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2017
-----------------------------------------------------
Last Update Date | 08/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 W COLLEGE ST
-----------------------------------------------------
City | COLUMBIANA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35051-9724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-210-4980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 944 VALLEY CIR
-----------------------------------------------------
City | LEEDS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35094-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-514-2854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------