Provider Demographics
NPI:1124782164
Name:BOUTEN, WILLIAM PAUL
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PAUL
Last Name:BOUTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710A ROCKLEDGE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2843
Mailing Address - Country:US
Mailing Address - Phone:301-515-0900
Mailing Address - Fax:
Practice Address - Street 1:6710A ROCKLEDGE DR STE 130
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2843
Practice Address - Country:US
Practice Address - Phone:301-515-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant