Doctor Name: | MR. WADE KENNEDY WILLIS |
NPI Number: | 1174601363 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MPT |
License Number: | 3935 |
Business Practice Address: | 6767 S Yale Ave Suite B Tulsa, OK - 741363302 |
Business Phone Number: | 9184889992 |
Business Fax Number: | 9184889993 |
Mailing Address: | 9275 Riverside Dr, Apt. X TULSA |
State: | OK |
Postal Code: | 741377331 |
Phone Number: | 9185490131 |
Fax Number: | |
NPI Enumeration Date: | 11/02/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 3935 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |