Individual
MR. DON P WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, PT, ATC
Contact information
Practice address
135 N WILLIAMSBURG DR, BLOOMINGTON, IL 61704-3528
(309) 664-9104
(309) 664-2913
Mailing address
PO BOX 5387, BLOOMINGTON, IL 61702-5387
(309) 661-8823
(309) 661-8801
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070012412
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146700
MEDICARE PART A
IL
01
—
3721757
BLUE CROSS BLUE SHIELD OF IL
IL
Enumeration date
03/23/2007
Last updated
04/20/2011
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