Provider Demographics
NPI:1649960667
Name:WILLS, STEPHEN C (LMT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:WILLS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 E BASELINE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6605
Mailing Address - Country:US
Mailing Address - Phone:480-431-9470
Mailing Address - Fax:
Practice Address - Street 1:916 E BASELINE RD STE 203
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6605
Practice Address - Country:US
Practice Address - Phone:480-431-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-27610225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty