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General NPI Number Information
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NPI Number | 1780239020
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Entity Type | Organization
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Legal Business Name | WILLIS PHYSICAL THERAPY GROUP PLLC
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 3800 JOE RAMSEY BLVD E STE B
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City | GREENVILLE
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State | TX
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Zip | 75401-7778
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Country | US
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Telephone | 903-355-2902
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Fax | 903-355-2909
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Provider Business Mailing Address
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Address Line | 3800 JOE RAMSEY BLVD E STE B
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City | GREENVILLE
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State | TX
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Zip | 75401-7778
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Country | US
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Telephone | 903-355-2902
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Fax | 903-355-2909
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Authorized Official
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Title or Position | OWNER, DPT
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Name | JAMES AUSTIN WILLIS
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Credential | DPT
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Telephone | 903-355-2902
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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 |
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License Number State |
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