Provider Demographics
NPI:1306841333
Name:WILLS, TERRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:WILLS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4165
Mailing Address - Country:US
Mailing Address - Phone:814-943-3668
Mailing Address - Fax:814-942-7635
Practice Address - Street 1:711 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4165
Practice Address - Country:US
Practice Address - Phone:814-943-3668
Practice Address - Fax:814-942-7635
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003314L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
203328OtherUPMC
2520552/4574572PPOOtherAETNA
8596-1327OtherGEISINGER
PA1502116OtherGATEWAY
99382OtherHEALTH AMERICA
WI548171OtherBC/BS
548171Medicare ID - Type Unspecified
203328OtherUPMC