Provider Demographics
NPI:1528655693
Name:MOAK, WILLIAM (PT)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:MOAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 FOREST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9421
Mailing Address - Country:US
Mailing Address - Phone:601-951-4739
Mailing Address - Fax:
Practice Address - Street 1:45 PLATEAU ST
Practice Address - Street 2:
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-4200
Practice Address - Country:US
Practice Address - Phone:828-488-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist