Individual
BEAU JUDSON WILLSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMBT
Contact information
Practice address
211 WB MCLEAN DR, CAPE CARTERET, NC 28584-8515
(910) 915-9433
Mailing address
202 COLDWATER DR, SWANSBORO, NC 28584-8256
(910) 915-9433
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13564
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13564
NC BOARD OF MASSAGE
NC
Enumeration date
09/03/2013
Last updated
11/01/2019
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