Individual
CHARLES C WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2649 E 75TH ST, CHICAGO, IL 60649-3835
(773) 356-9300
Mailing address
2649 E 75TH ST, CHICAGO, IL 60649-3835
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160007583
IL
Other
Enumeration date
11/18/2016
Last updated
11/18/2016
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