Provider Demographics
NPI:1851923676
Name:WILLOUGHBY, DREW AUSTIN GARNER (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:AUSTIN GARNER
Last Name:WILLOUGHBY
Suffix:
Gender:M
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 1:314 HIGHLAND SPRING LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2055
Mailing Address - Country:US
Mailing Address - Phone:512-632-2424
Mailing Address - Fax:
Practice Address - Street 1:700 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:TX
Practice Address - Zip Code:76648-2517
Practice Address - Country:US
Practice Address - Phone:254-582-2713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1328335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist