1225252893 NPI number — MRS. TRICIA CAMILLE WILLEFORD PHYSICAL THERAPIST

Table of content: MRS. TRICIA CAMILLE WILLEFORD PHYSICAL THERAPIST (NPI 1225252893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225252893 NPI number — MRS. TRICIA CAMILLE WILLEFORD PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLEFORD
Provider First Name:
TRICIA
Provider Middle Name:
CAMILLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALLIN
Provider Other First Name:
TRICIA
Provider Other Middle Name:
CAMILLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225252893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11155 450TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAURENS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50554-8727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-845-2133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 1ST STREET
Provider Second Line Business Practice Location Address:
PALO ALTO COUNTY HOSPITAL
Provider Business Practice Location Address City Name:
EMMETSBURG
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-852-5420
Provider Business Practice Location Address Fax Number:
712-852-5524
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  02398 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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