Individual
MR. BRENT ALAN WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
901 BETHESDA RD, WINSTON SALEM, NC 27103-3015
(336) 768-2211
Mailing address
5133 RIVER CHASE RDG, WINSTON SALEM, NC 27104-4470
(336) 765-7796
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
876
NC
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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