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NPI Code Detail

MEDICARE: MS. ALMA SUE WILLIS PTA

MEDICARE: MS. ALMA SUE WILLIS PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant8040AAZ

General Provider Information

NPI Number : 1720249980
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALMA SUE WILLIS PTA
Provider Business Mailing Address
First Line : 375 FAIRWAY OAKS DR
Second Line :
City : SEDONA
State : AZ
Zip : 86351-9096
Country : US
Telephone Number : 574-329-6287
Fax Number :
Provider Business Practice Location Address
First Line : 505 JACKS CANYON RD
Second Line :
City : SEDONA
State : AZ
Zip : 86351-7856
Country : US
Telephone Number : 928-284-2439
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2008
Last Update Date : 06/20/2008

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