| Doctor Name: | JUSTIN RYAN WILLIS |
| NPI Number: | 1003186446 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMT |
| License Number: | |
| Business Practice Address: | 12409 Albion St Thornton, CO - 802412932 |
| Business Phone Number: | 3035250573 |
| Business Fax Number: | |
| Mailing Address: | 12409 Albion St, THORNTON |
| State: | CO |
| Postal Code: | 802412932 |
| Phone Number: | 3035250573 |
| Fax Number: | |
| NPI Enumeration Date: | 01/03/2012 |
| NPI Last Update Date: | 01/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 224Y00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Clinical Exercise Physiologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A Clinical Exercise Physiologist is a health care professional who is trained to work with patients with chronic disease where exercise training has been shown to be of therapeutic benefit, including but not limited to cardiovascular and pulmonary disease, and metabolic disorders. |