Provider Demographics
NPI:1528737780
Name:WILLARD PHYSICAL THERAPY CENTER LLC
Entity type:Organization
Organization Name:WILLARD PHYSICAL THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:KALA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, ATC
Authorized Official - Phone:417-221-4667
Mailing Address - Street 1:PO BOX 257
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-0257
Mailing Address - Country:US
Mailing Address - Phone:417-221-4667
Mailing Address - Fax:417-744-9674
Practice Address - Street 1:304 E JACKSON ST # 2F
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-9333
Practice Address - Country:US
Practice Address - Phone:417-827-9153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy