Healthcare Provider Details

I. General information

NPI: 1841108255
Provider Name (Legal Business Name): STEPHANIE WILLS PTA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12110 S HARRELLS FERRY RD STE 200
BATON ROUGE LA
70816-2426
US

IV. Provider business mailing address

12110 S HARRELLS FERRY RD STE 200
BATON ROUGE LA
70816-2426
US

V. Phone/Fax

Practice location:
  • Phone: 225-372-5008
  • Fax: 225-308-4704
Mailing address:
  • Phone: 225-372-5008
  • Fax: 225-308-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberA11204
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: