Individual
MR. WILLIAM M GANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4005 LAMAR AVENUE, PARIS, TX 75462
(903) 785-3861
(903) 739-8768
Mailing address
4005 LAMAR AVENUE, PARIS, TX 75462
(903) 785-3861
(903) 739-8768
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1052538
TX
2251S0007X
Sports Physical Therapist
1052538
TX
2251X0800X
Orthopedic Physical Therapist
Primary
1052538
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058543201
—
TX
05
—
100835750A
—
OK
01
—
120494
SUPERIOR PROVIDER NUMBER
—
01
—
7445440
AETNA PROVIDER NUMBER
—
01
—
80815T
BCBS PROVIDER NUMBER
TX
Enumeration date
06/08/2006
Last updated
07/18/2015
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