Provider Demographics
NPI:1376815985
Name:WILLS, TONYA LYNN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:LYNN
Last Name:WILLS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MRS
Other - First Name:TONYA
Other - Middle Name:LYNN
Other - Last Name:DEBARBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:P.O. BOX 1242
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741
Mailing Address - Country:US
Mailing Address - Phone:808-639-3520
Mailing Address - Fax:
Practice Address - Street 1:401 PAPALOA RD
Practice Address - Street 2:SUITE 205
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1418
Practice Address - Country:US
Practice Address - Phone:808-652-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist