Individual
REGINALD WILLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
206 MARYLAND AVE, MCCOMB, MS 39648-3926
(601) 250-4815
Mailing address
82569 HIGHWAY 1080, FOLSOM, LA 70437-5117
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
02/04/2008
Last updated
02/04/2008
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