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General NPI Number Information
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NPI Number | 1023298288
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Entity Type | Individual
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Provider Name | DONNA SUZANNE WILLEFORD PT
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Gender | Female
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 916 SW 38TH ST STE C
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City | LAWTON
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State | OK
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Zip | 73505-7005
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Country | US
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Telephone | 580-599-0919
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Fax | 580-599-0955
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Provider Business Mailing Address
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Address Line | PO BOX 932184
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City | ATLANTA
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State | GA
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Zip | 31193-2184
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2227
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License Number State | OK
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