Individual
MS. DIANE THERESE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
580 FOXTAIL DR APT 101, PEWAUKEE, WI 53072-2492
(262) 719-4349
Mailing address
580 FOXTAIL DR APT 101, PEWAUKEE, WI 53072-2492
(262) 719-4349
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12802-146
WI
Other
Enumeration date
03/26/2020
Last updated
03/26/2020
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