Provider Demographics
NPI:1902898091
Name:MONROE, WILLIAM BRIAN (DPT OCS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRIAN
Last Name:MONROE
Suffix:
Gender:M
Credentials:DPT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301
Mailing Address - Country:US
Mailing Address - Phone:661-327-4357
Mailing Address - Fax:661-327-2311
Practice Address - Street 1:3700 GOSFORD RD
Practice Address - Street 2:SUITE G
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7694
Practice Address - Country:US
Practice Address - Phone:661-832-9737
Practice Address - Fax:661-832-9738
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ255YOtherMEDICARE INDIVIDUAL PTAN LINKED TO TS
CAAZ255ZOtherMEDICARE PTAN
CAP00113619OtherRAILROAD MEDICARE PTAN
CAZZZ21297ZOtherMEDICARE GROUP PTAN
CAP00113619OtherRAILROAD MEDICARE PTAN