Provider Demographics
NPI:1346694494
Name:WILLIS, CRAIG AUGUST (DPT)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:AUGUST
Last Name:WILLIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6830 W OQUENDO RD
Mailing Address - Street 2:101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2539
Mailing Address - Country:US
Mailing Address - Phone:702-258-3066
Mailing Address - Fax:702-258-1907
Practice Address - Street 1:790 REMINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4909
Practice Address - Country:US
Practice Address - Phone:630-296-2223
Practice Address - Fax:630-759-9510
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist