Provider Demographics
NPI:1811443120
Name:WILLIS, BRITTANY JESSEE
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JESSEE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:NICOLE
Other - Last Name:JESSEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1326 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-465-8823
Practice Address - Street 1:11424 SULLIVAN RD
Practice Address - Street 2:BLDG 3, STE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3615
Practice Address - Country:US
Practice Address - Phone:225-261-7021
Practice Address - Fax:225-262-1826
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
LA11366R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer