Individual
JUSTIN RYAN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
12409 ALBION ST, THORNTON, CO 80241-2932
(303) 525-0573
Mailing address
12409 ALBION ST, THORNTON, CO 80241-2932
(303) 525-0573
Taxonomy
Speciality
Code
Description
License number
State
224Y00000X
Clinical Exercise Physiologist
—
CO
225700000X
Massage Therapist
Primary
2910
CO
Other
Enumeration date
01/03/2012
Last updated
01/03/2012
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