Active NPI
Craig August Willis, DPT
- Physical Therapist
- Bolingbrook, IL
National Provider Identifier
1346694494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3297
- Practice address
- 790 Remington Blvd
Bolingbrook, IL 60440-4909 - Phone
- (630) 296-2223
- Fax
- (630) 759-9510
- NPI assigned
- Apr 14, 2016
- Sex
- Male
- Sole proprietor
- No
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 Therapist | 225100000X | 3297 | NV | Primary |
Addresses
Primary practice location
790 Remington Blvd
Bolingbrook, IL 60440-4909
Mailing address
6830 W Oquendo Rd
101
Las Vegas, NV 89118-2539
Phone (702) 258-3066
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3297 | NV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464739200000",
"number": "1346694494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6830 W OQUENDO RD",
"address_2": "101",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891182539",
"telephone_number": "702-258-3066",
"fax_number": "702-258-1907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223",
"fax_number": "630-759-9510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "CRAIG",
"middle_name": "AUGUST",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-04-14",
"last_updated": "2016-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NV",
"license": "3297",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolingbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.