MEDICARE: MR. WILLIAM FRANKLIN MCKEITHEN JR. PTA

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	225200000X	Physical Therapy Assistant	19354	FL

General Provider Information

NPI Number	:	1124767025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM FRANKLIN MCKEITHEN JR. PTA

Provider Business Mailing Address
First Line	:	13728 SUNRISE LN
Second Line	:
City	:	SOUTHPORT
State	:	FL
Zip	:	32409-2597
Country	:	US
Telephone Number	:	850-348-1355
Fax Number	:

Provider Business Practice Location Address
First Line	:	13728 SUNRISE LN
Second Line	:
City	:	SOUTHPORT
State	:	FL
Zip	:	32409-2597
Country	:	US
Telephone Number	:	850-348-1355
Fax Number	:

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	05/31/2022

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Directions to “ MR. WILLIAM FRANKLIN MCKEITHEN JR. PTA” Practice Location

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