Provider Demographics
NPI:1780421503
Name:PIGGEE, WILLIE CENTEL JR
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:CENTEL
Last Name:PIGGEE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11542
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1542
Mailing Address - Country:US
Mailing Address - Phone:479-459-2700
Mailing Address - Fax:
Practice Address - Street 1:810 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4942
Practice Address - Country:US
Practice Address - Phone:479-441-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist