Provider Demographics
NPI:1417732652
Name:WILLS, AGRAPINA (CMT)
Entity Type:Individual
Prefix:
First Name:AGRAPINA
Middle Name:
Last Name:WILLS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13672 FALMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-5218
Mailing Address - Country:US
Mailing Address - Phone:385-499-7737
Mailing Address - Fax:
Practice Address - Street 1:202 FASHION LN
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3302
Practice Address - Country:US
Practice Address - Phone:385-499-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8910875-4701225700000X
CA89852225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist