Davonna Marie Willis, ATC, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT-12710 Issued in AZ

Practice address

625 N Gilbert Rd
Suite 103
Gilbert, AZ 85234-3398

Phone

(480) 779-0744

NPI assigned

Nov 16, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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": "1479254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479254400000",
    "number": "1649712019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 N GILBERT RD",
            "address_2": "SUITE 103",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852343398",
            "telephone_number": "480-779-0744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 N GILBERT RD",
            "address_2": "SUITE 103",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852343398",
            "telephone_number": "480-779-0744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "DAVONNA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "ATC, LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-16",
        "last_updated": "2016-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "AZ",
            "license": "MT-12710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terry Lance Williams, O.D.
• Tiffany Williams
• Kendra Taylor Williamson, NP
• Alma Angelica Willis
• Bruce James Willis
• Ryanne Willis, M.ED, BCBA
• Jordan Daniel Willoughby, PA-C
• Willow Midwife Center for Birth and Wellness Az, LLC
• Braeden Wills
• Richard C Wilsey, LMT

• Massage Therapist in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Massage Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.

Verify at the official NPI Registry.