Individual
MR. MARK A WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
1514 OWENS ST, GADSDEN, AL 35904-4938
(256) 543-1030
(256) 439-2830
Mailing address
1514 OWENS ST, GADSDEN, AL 35904-4938
(256) 543-1030
(256) 439-2830
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH3505
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515-18415
BCBS OF ALABAMA
AL
01
—
P82493
UPIN
AL
Enumeration date
06/30/2006
Last updated
07/08/2007
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