Provider Demographics
NPI:1225252893
Name:WILLEFORD, TRICIA CAMILLE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:CAMILLE
Last Name:WILLEFORD
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MRS
Other - First Name:TRICIA
Other - Middle Name:CAMILLE
Other - Last Name:WALLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:11155 450TH ST
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:IA
Mailing Address - Zip Code:50554-8727
Mailing Address - Country:US
Mailing Address - Phone:712-845-2133
Mailing Address - Fax:
Practice Address - Street 1:3201 1ST STREET
Practice Address - Street 2:PALO ALTO COUNTY HOSPITAL
Practice Address - City:EMMETSBURG
Practice Address - State:IA
Practice Address - Zip Code:50536
Practice Address - Country:US
Practice Address - Phone:712-852-5420
Practice Address - Fax:712-852-5524
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist