Individual
MRS. DAVONNA MARIE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LMT
Contact information
Practice address
625 N GILBERT RD, SUITE 103, GILBERT, AZ 85234-3398
(480) 779-0744
Mailing address
625 N GILBERT RD, SUITE 103, GILBERT, AZ 85234-3398
(480) 779-0744
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
225700000X
Massage Therapist
Primary
MT-12710
AZ
Other
Enumeration date
11/16/2016
Last updated
11/16/2016
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