Diane Therese Willis, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

12802-146 Issued in WI

Practice address

580 Foxtail Dr Apt 101
Pewaukee, WI 53072-2492

Phone

(262) 719-4349

NPI assigned

Mar 26, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Diane Therese Glancey Willis Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1144857343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 FOXTAIL DR APT 101",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530722492",
            "telephone_number": "262-719-4349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 FOXTAIL DR APT 101",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530722492",
            "telephone_number": "262-719-4349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "DIANE",
        "middle_name": "THERESE",
        "name_prefix": "Ms.",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-26",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WI",
            "license": "12802-146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "GLANCEY WILLIS",
            "middle_name": "THERESE",
            "credential": "LMT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jessica Helena Wieland, RN
• Nicole L Wierzbicki, PT
• Nicholas Wilcox, M.D.
• Danielle E Willey, PA-C
• Ryan Murphy Willging, PT
• Steve Christopher Wilsens, D.C.
• Lauren Wirth, MS, CCC-SLP
• Wisconsin CVS Pharmacy LLC
• Wisconsin Dental Group, S.C.
• Wisconsin Vein Center and Medispa, SC

• Massage Therapist in Pewaukee, WI
• Providers in Pewaukee, WI by specialty
• Massage Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.