Individual
WILLIAM JOHN BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
902 E 12TH AVE, WEBSTER, SD 57274-2300
(956) 451-1907
Mailing address
902 E. 12TH AVE, WEBSTER, SD 57274
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
2061050
TX
225200000X
Physical Therapy Assistant
Primary
008793
NY
Other
Enumeration date
06/08/2012
Last updated
07/15/2020
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