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General NPI Number Information
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NPI Number | 1417732652
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Entity Type | Individual
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Provider Name | AGRAPINA WILLS CMT
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Gender | Female
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 202 FASHION LN
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City | TUSTIN
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State | CA
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Zip | 92780-3302
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Country | US
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Telephone | 385-499-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 13672 FALMOUTH DR
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City | TUSTIN
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State | CA
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Zip | 92780-5218
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Country | US
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Telephone | 385-499-7737
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 8910875-4701
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 89852
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License Number State | CA
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