Individual
KEVIN WILLENBRING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
105 MOORES GROVE RD, WINTERVILLE, GA 30683-1517
(706) 742-0082
(706) 742-0083
Mailing address
500 MARKET ST, SUITE 103, BEAVER, PA 15009-2998
(724) 728-7550
(724) 728-6648
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT010676
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
989933131A
—
GA
01
—
PT010676
PT LICENSE NUMBER
GA
Enumeration date
08/09/2012
Last updated
02/28/2013
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