Provider Demographics
NPI:1801029426
Name:WILLOW TREE WELLNESS & THERAPY INC
Entity Type:Organization
Organization Name:WILLOW TREE WELLNESS & THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:864-363-7046
Mailing Address - Street 1:3014 WADE HAMPTON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-2716
Mailing Address - Country:US
Mailing Address - Phone:864-277-6242
Mailing Address - Fax:
Practice Address - Street 1:3014 WADE HAMPTON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2716
Practice Address - Country:US
Practice Address - Phone:864-277-6242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC48162251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty