Jeremy Alan Willard, PTA
Individual provider Active NPI Physical Therapy Assistant · Norwood, NY
NPI 1124190327 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124190327
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 0055051 (NY)
- Practice address
- St. Lawrence Ntsarc Inc
63 1-2 B South Main Street
Norwood, NY 13668 - Phone
- (315) 353-6652
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0055051 | NY | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 0055051 | NY | Yes |
Addresses
Primary practice location
St. Lawrence Ntsarc Inc
63 1-2 B South Main Street
Norwood, NY 13668
Mailing address
50 West Parishville Rd
Potsdam, NY 13676
Phone (315) 268-1915
Other providers in Norwood, NY
- Northwoods Furniture
- Norwood Norfolk Central School
- Margo Ellen Taylor
- Anna Teresa Volpe-Berghaus
- Heidi Weaver
All providers in Norwood, NY · Physical Therapy Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.