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General NPI Number Information
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NPI Number | 1629960802
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Entity Type | Individual
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Provider Name | NICHOLAS SCOTT WILLISS DPT
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Gender | Male
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 115 ALMOND DR
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City | ARAB
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State | AL
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Zip | 35016-3749
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Country | US
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Telephone | 256-224-6193
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Fax |
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Provider Business Mailing Address
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Address Line | 631 CRESTMAN DR SW
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City | ARAB
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State | AL
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Zip | 35016-6701
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Country | US
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Telephone | 256-200-6009
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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 | PTH11833
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License Number State | AL
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