Provider Demographics
NPI:1215714928
Name:WILLEY, ERIC LEE (PTA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:LEE
Last Name:WILLEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 SILAS RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ARARAT
Mailing Address - State:NC
Mailing Address - Zip Code:27007-8466
Mailing Address - Country:US
Mailing Address - Phone:743-444-2705
Mailing Address - Fax:
Practice Address - Street 1:500 S DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1758
Practice Address - Country:US
Practice Address - Phone:302-422-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECP025142A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant