| Doctor Name: | BEAU JUDSON WILLSEY |
| NPI Number: | 1689009151 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMBT |
| License Number: | 13564 |
| Business Practice Address: | 134 Sw Knox St Lake City, FL - 320255259 |
| Business Phone Number: | 3867199481 |
| Business Fax Number: | |
| Mailing Address: | 198 Charlie Taylor Rd, HUBERT |
| State: | NC |
| Postal Code: | 285393902 |
| Phone Number: | 9109159433 |
| Fax Number: | |
| NPI Enumeration Date: | 09/03/2013 |
| NPI Last Update Date: | 10/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 13564 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |