MEDICARE: DR. NATASHA WILLIS P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	036595	NY
2	225200000X	Physical Therapy Assistant	0070461-1	NY

General Provider Information

NPI Number	:	1043543432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATASHA WILLIS P.T.

Provider Business Mailing Address
First Line	:	3 BRIDGE ST
Second Line	:
City	:	CARTHAGE
State	:	NY
Zip	:	13619-1360
Country	:	US
Telephone Number	:	315-493-1340
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 BRIDGE ST
Second Line	:
City	:	CARTHAGE
State	:	NY
Zip	:	13619-1360
Country	:	US
Telephone Number	:	315-493-1340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	01/04/2018

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Directions to “ DR. NATASHA WILLIS P.T.” Practice Location

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