Provider Demographics
NPI:1285166249
Name:WILLIAM, DAMON ANTHONY (DPT)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:ANTHONY
Last Name:WILLIAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 NW 104TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-5103
Mailing Address - Country:US
Mailing Address - Phone:617-804-2040
Mailing Address - Fax:
Practice Address - Street 1:5025 GAILLARDIA CORPORATE PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-1888
Practice Address - Country:US
Practice Address - Phone:405-314-7137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist