Individual
MRS. KIMBERLY RENEE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
(601) 605-8869
Mailing address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
(601) 605-8869
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1719
MS
Other
Enumeration date
09/12/2007
Last updated
09/12/2007
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