Individual
SHANETTA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
116 WILDWOOD CIR, EL DORADO, AR 71730-2424
(870) 310-7226
Mailing address
116 WILDWOOD CIR, EL DORADO, AR 71730-2424
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 2374
AR
Other
Enumeration date
07/27/2011
Last updated
07/27/2011
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