Provider Demographics
NPI:1790576387
Name:WILLINGHAM, CALANDRA CHARNELE (PTA)
Entity type:Individual
Prefix:
First Name:CALANDRA
Middle Name:CHARNELE
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10043 REVOLUTION CT APT F
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1280
Mailing Address - Country:US
Mailing Address - Phone:910-568-6800
Mailing Address - Fax:
Practice Address - Street 1:10043 REVOLUTION CT APT F
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1280
Practice Address - Country:US
Practice Address - Phone:910-568-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6173225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant