Provider Demographics
NPI:1467821447
Name:WILLSEY, THEODORE (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:WILLSEY
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 GOLDSBORO RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5826
Mailing Address - Country:US
Mailing Address - Phone:301-493-8884
Mailing Address - Fax:
Practice Address - Street 1:6400 GOLDSBORO RD
Practice Address - Street 2:SUITE 340
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-5826
Practice Address - Country:US
Practice Address - Phone:301-493-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist