Individual provider · NPI-1

William Tyler Dubose

Kinesiotherapist · Lake City, FL

NPI number1700666922
StatusActive
Last updated in NPPESJul 1, 2026

Details

NPI
1700666922
Entity type
Individual (NPI-1)
Name
William Tyler Dubose
Sex
Male
Sole proprietor
No
Enumeration date
Oct 4, 2023
Certification date
Jul 1, 2026
Last updated
Jul 1, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
226300000X Kinesiotherapist–MSYes
225700000X Massage Therapist4037MS

Practice location

619 S Marion Ave
Lake City, FL 32025-5808

Phone 386-755-3016

Mailing address

55 Arnett Rd
Hattiesburg, MS 39401-9486

Phone 769-223-3800

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