Provider Demographics
NPI:1669048021
Name:WILLIS, RYLAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYLAN
Middle Name:
Last Name:WILLIS
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 1:3435 SILVERBELL RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0386
Mailing Address - Country:US
Mailing Address - Phone:530-774-2261
Mailing Address - Fax:
Practice Address - Street 1:468 MANZANITA AVE STE 3
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1358
Practice Address - Country:US
Practice Address - Phone:530-774-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT296981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist