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General NPI Number Information
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NPI Number | 1801029426
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Entity Type | Organization
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Legal Business Name | WILLOW TREE WELLNESS & THERAPY INC
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Dates
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Enumeration Date | 08/30/2009
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Last Update Date | 08/30/2009
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Provider Practice Location Address
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Address Line | 3014 WADE HAMPTON BLVD SUITE B
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City | TAYLORS
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State | SC
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Zip | 29687-2716
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Country | US
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Telephone | 864-277-6242
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Fax |
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Provider Business Mailing Address
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Address Line | 3014 WADE HAMPTON BLVD SUITE B
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City | TAYLORS
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State | SC
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Zip | 29687-2716
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Country | US
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Telephone | 864-277-6242
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Fax |
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Authorized Official
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Title or Position | OWNER - PRESIDENT
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Name | MR. JENNIFER B WILLIAMS
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Credential | PT
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Telephone | 864-363-7046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 4816
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License Number State | SC
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