Provider Demographics
NPI:1699256917
Name:GUSMUS, WILLIAM PAUL II (LPTA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PAUL
Last Name:GUSMUS
Suffix:II
Gender:M
Credentials:LPTA
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Mailing Address - Street 1:50 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-2946
Mailing Address - Country:US
Mailing Address - Phone:662-473-4777
Mailing Address - Fax:662-473-2233
Practice Address - Street 1:109 EUREKA ST STE A
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2534
Practice Address - Country:US
Practice Address - Phone:662-578-7799
Practice Address - Fax:662-578-7992
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS5779225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant