Provider Demographics
NPI:1528137643
Name:WILLS, JEFFREY R (PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:WILLS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9725 W SUNSET HWY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9426
Mailing Address - Country:US
Mailing Address - Phone:509-624-4100
Mailing Address - Fax:509-624-2297
Practice Address - Street 1:9725 W SUNSET HWY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9426
Practice Address - Country:US
Practice Address - Phone:509-624-4100
Practice Address - Fax:509-624-2297
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8343584Medicaid
WA8343584Medicaid