Provider Demographics
NPI:1720249980
Name:WILLIS, ALMA SUE (PTA)
Entity Type:Individual
Prefix:MS
First Name:ALMA
Middle Name:SUE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:375 FAIRWAY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-9096
Mailing Address - Country:US
Mailing Address - Phone:574-329-6287
Mailing Address - Fax:
Practice Address - Street 1:505 JACKS CANYON RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-7856
Practice Address - Country:US
Practice Address - Phone:928-284-2439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8040A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant