Provider Demographics
NPI:1770864118
Name:WILLIS, BARRY JAMES (MSPT, GCS)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:JAMES
Last Name:WILLIS
Suffix:
Gender:M
Credentials:MSPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 POTTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2010
Mailing Address - Country:US
Mailing Address - Phone:360-876-8035
Mailing Address - Fax:360-895-5336
Practice Address - Street 1:2031 POTTERY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2010
Practice Address - Country:US
Practice Address - Phone:360-876-8035
Practice Address - Fax:360-895-5336
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000069592251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics