Provider Demographics
NPI:1811202542
Name:WILLIS, D. ANITA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:D.
Middle Name:ANITA
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 DEL NORTE AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4125
Mailing Address - Country:US
Mailing Address - Phone:530-870-8588
Mailing Address - Fax:530-870-8233
Practice Address - Street 1:466 DEL NORTE AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4125
Practice Address - Country:US
Practice Address - Phone:530-870-8588
Practice Address - Fax:530-870-8233
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 11583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist