Provider Demographics
NPI:1316237787
Name:SPIVEY, WILLIAM EDWARD (PT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:SPIVEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:EDWARD
Other - Last Name:SPIVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:508 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4349
Mailing Address - Country:US
Mailing Address - Phone:505-454-0443
Mailing Address - Fax:505-454-0498
Practice Address - Street 1:508 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4349
Practice Address - Country:US
Practice Address - Phone:505-454-0443
Practice Address - Fax:505-454-0498
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist