MEDICARE: DRITA WILLCOX

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	225200000X	Physical Therapy Assistant	8753	CA

General Provider Information

NPI Number	:	1225305378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DRITA WILLCOX

Provider Business Mailing Address
First Line	:	2245 RIVER RUN DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5885
Country	:	US
Telephone Number	:	440-454-0873
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 RIVER RUN DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5885
Country	:	US
Telephone Number	:	440-454-0873
Fax Number	:

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

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	11/17/2011

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Directions to “ DRITA WILLCOX ” Practice Location

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