Provider Demographics
NPI:1841464005
Name:WILLS, RICHARD (LMP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WILLS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31808 79TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-9613
Mailing Address - Country:US
Mailing Address - Phone:360-370-5040
Mailing Address - Fax:
Practice Address - Street 1:22705 MERIDIAN AVE E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-7098
Practice Address - Country:US
Practice Address - Phone:360-370-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60014332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist