Provider Demographics
NPI:1043608649
Name:WILLOUGHBY, JAMES ALLEN (ATC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:WILLOUGHBY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-3299
Mailing Address - Country:US
Mailing Address - Phone:719-333-9330
Mailing Address - Fax:
Practice Address - Street 1:5220 CEDAR DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-3299
Practice Address - Country:US
Practice Address - Phone:719-333-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer