Active NPI
Christopher M Willis, PTA
- Physical Therapy Assistant
- Magnolia, AR
National Provider Identifier
1326301508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA 2603
- Practice address
- 211 E Stadium
Magnolia, AR 71753-2032 - Phone
- (870) 234-7604
- Fax
- (870) 234-6669
- NPI assigned
- Jun 21, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA 2603 | AR | Primary |
Addresses
Primary practice location
211 E Stadium
Magnolia, AR 71753-2032
Mailing address
1420 Terrace
Magnolia, AR 71753-2041
Phone (870) 904-7571
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA 2603 | AR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340236800000",
"number": "1326301508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 TERRACE",
"city": "MAGNOLIA",
"state": "AR",
"postal_code": "717532041",
"telephone_number": "870-904-7571",
"fax_number": "870-234-6669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 E STADIUM",
"city": "MAGNOLIA",
"state": "AR",
"postal_code": "717532032",
"telephone_number": "870-234-7604",
"fax_number": "870-234-6669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "CHRISTOPHER",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-21",
"last_updated": "2012-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AR",
"license": "PTA 2603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Magnolia, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.