Provider Demographics
NPI:1447956388
Name:WILLOUGHBY, JOHN ALAN (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:WILLOUGHBY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BLACK OAK CT
Mailing Address - Street 2:
Mailing Address - City:CATAULA
Mailing Address - State:GA
Mailing Address - Zip Code:31804-2758
Mailing Address - Country:US
Mailing Address - Phone:706-577-3140
Mailing Address - Fax:
Practice Address - Street 1:106 ENTERPRISE CT STE C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9096
Practice Address - Country:US
Practice Address - Phone:706-221-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist