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General NPI Number Information
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NPI Number | 1316974124
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Entity Type | Individual
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Provider Name | TONI WILLIS MD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 3020 W WHEATLAND RD
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City | DALLAS
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State | TX
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Zip | 75237-3537
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Country | US
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Telephone | 972-708-8667
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Fax | 972-708-8692
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Provider Business Mailing Address
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Address Line | 2600 E SOUTHLAKE BLVD SUITE 120-293
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6634
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Country | US
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Telephone | 817-723-6378
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Fax | 972-708-8692
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | L0703
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License Number State | TX
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