Basic Information
| Provider Information | |||||||||
| NPI: | 1003855776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIS | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13163 FOUNTAIN PARK DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PLAYA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900942040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108232220 | ||||||||
| FaxNumber: | 3108232636 | ||||||||
| Practice Location | |||||||||
| Address1: | 13163 FOUNTAIN PARK DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PLAYA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900942040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108232220 | ||||||||
| FaxNumber: | 3108232636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 09/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 25468 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.