Provider Demographics
NPI:1679015150
Name:MOONEYHAM, WILLIAM EDSON III (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDSON
Last Name:MOONEYHAM
Suffix:III
Gender:M
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:CJ
Other - Middle Name:EDSON
Other - Last Name:MOONEYHAM
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:701 W CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6015
Mailing Address - Country:US
Mailing Address - Phone:559-713-6806
Mailing Address - Fax:559-713-6809
Practice Address - Street 1:570 COLLINS DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3121
Practice Address - Country:US
Practice Address - Phone:209-723-0807
Practice Address - Fax:209-723-6413
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist