MEDICARE: DR. WILLIAM GRESHAM DPT

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	2305212309	VA

General Provider Information

NPI Number	:	1730039215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM GRESHAM DPT

Provider Business Mailing Address
First Line	:	1401 BOULDER SPRINGS TER APT 5302
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-5598
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8191 STAPLES MILL RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2751
Country	:	US
Telephone Number	:	804-523-2653
Fax Number	:

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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