Provider Demographics
NPI:1275057671
Name:WILLMAN, DESIREE N (DPT)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:N
Last Name:WILLMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:N
Other - Last Name:LENNIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:911 W INTERSTATE AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0955
Mailing Address - Country:US
Mailing Address - Phone:701-223-8717
Mailing Address - Fax:701-255-3957
Practice Address - Street 1:911 W INTERSTATE AVE STE 12
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0955
Practice Address - Country:US
Practice Address - Phone:701-223-8717
Practice Address - Fax:701-255-3957
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPT2098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDPT2098OtherPT LICENSE