Provider Demographics
NPI:1568131696
Name:WILLINGHAM, KHALEELA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KHALEELA
Middle Name:
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 DORCHESTER AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125-4499
Mailing Address - Country:US
Mailing Address - Phone:857-544-8727
Mailing Address - Fax:
Practice Address - Street 1:500 W CUMMINGS PARK STE 2100
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6513
Practice Address - Country:US
Practice Address - Phone:781-305-4656
Practice Address - Fax:781-305-4658
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist