Provider Demographics
NPI:1396357760
Name:PURCELL, WILLIAM CODY (LAT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CODY
Last Name:PURCELL
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N DAY MIAR RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8106
Mailing Address - Country:US
Mailing Address - Phone:682-314-0439
Mailing Address - Fax:
Practice Address - Street 1:101 N DAY MIAR RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8106
Practice Address - Country:US
Practice Address - Phone:682-314-0349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT24532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer