MEDICARE: MELISSA WILLIS

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	5541	AZ

General Provider Information

NPI Number	:	1659060895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA WILLIS

Provider Business Mailing Address
First Line	:	7509 E ALMERIA RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-1551
Country	:	US
Telephone Number	:	480-335-0518
Fax Number	:

Provider Business Practice Location Address
First Line	:	8107 E ROOSEVELT ST
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-3818
Country	:	US
Telephone Number	:	480-335-0518
Fax Number	:

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

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	05/03/2023

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Directions to “ MELISSA WILLIS ” Practice Location

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