Provider Demographics
NPI:1508099631
Name:WILLS, KATHY (DPT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:WILLS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:ONDISHKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2829
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-2829
Mailing Address - Country:US
Mailing Address - Phone:912-756-5699
Mailing Address - Fax:912-756-5388
Practice Address - Street 1:2709 US HIGHWAY 17 STE A2
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3795
Practice Address - Country:US
Practice Address - Phone:912-756-5699
Practice Address - Fax:912-756-5388
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist