Provider Demographics
NPI:1457163081
Name:ATKINS, WILLIAM GLENN III
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GLENN
Last Name:ATKINS
Suffix:III
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27671 VIA SEQUOIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5302
Mailing Address - Country:US
Mailing Address - Phone:949-842-5256
Mailing Address - Fax:
Practice Address - Street 1:27671 VIA SEQUOIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-5302
Practice Address - Country:US
Practice Address - Phone:949-842-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90501225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist