Basic Information
Provider Information
NPI: 1639840937
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAMBERT
FirstName: WILLIAM
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 350 NEW FIDELITY CT
Address2:  
City: GARNER
State: NC
PostalCode: 275292665
CountryCode: US
TelephoneNumber: 9192582714
FaxNumber: 4106484878
Practice Location
Address1: 1490 PANTOPS MOUNTAIN PL
Address2:  
City: CHARLOTTESVILLE
State: VA
PostalCode: 229114601
CountryCode: US
TelephoneNumber: 4342456472
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/26/2021
LastUpdateDate: 10/07/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X2305214652VAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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