Provider Demographics
NPI:1992307532
Name:WILLIS, TASHNEE AMANDA (DPT)
Entity type:Individual
Prefix:MISS
First Name:TASHNEE
Middle Name:AMANDA
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 TRIUNFO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2525
Mailing Address - Country:US
Mailing Address - Phone:805-373-6560
Mailing Address - Fax:805-373-5120
Practice Address - Street 1:141 TRIUNFO CANYON RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2525
Practice Address - Country:US
Practice Address - Phone:805-373-6560
Practice Address - Fax:805-373-5120
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist