Waggoner, William Wallace

Waggoner, William Wallace is an individual health care provider with primary practice located at 500 Sagamore Pkwy W Ste 2W , West Lafayette IN 47906-1459. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Waggoner, William Wallace can be contacted via phone (765) 250-9660.

Contact Information

Primary practice address
500 Sagamore Pkwy W Ste 2W West Lafayette IN 47906-1459
Phone: (765) 250-9660
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 05006050A Indiana

Profile Details

NPI number 1255368049
LBN Legal business name Waggoner, William Wallace
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 27th, 2006
Last updated Jan 22nd, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1255368049 NPPES
Indiana Other 000000527519 ANTHEM PROVIDER NUMBER
Indiana MEDICAID 200307360 ANTHEM PROVIDER NUMBER

Popular Providers