Provider Demographics
NPI:1477785855
Name:WILLMARTH, PATRICIA BENNETT (PT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:BENNETT
Last Name:WILLMARTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MORAN RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3606
Mailing Address - Country:US
Mailing Address - Phone:313-882-3143
Mailing Address - Fax:
Practice Address - Street 1:5447 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-4009
Practice Address - Country:US
Practice Address - Phone:313-832-1100
Practice Address - Fax:313-578-4507
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist