Individual
MR. JEREMY ALAN WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
ST. LAWRENCE NTSARC INC, 63 1-2 B SOUTH MAIN STREET, NORWOOD, NY 13668
(315) 353-6652
Mailing address
50 WEST PARISHVILLE RD, POTSDAM, NY 13676
(315) 268-1915
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0055051
NY
Other
Enumeration date
11/14/2006
Last updated
07/08/2007
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