Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shanique Tiarra Willis

Individual provider Physical Therapy Assistant · NPI 1740054212

Shanique Tiarra Willis is a Physical Therapy Assistant in Ferriday, Louisiana. Practices as a sole proprietor. Licensed in Georgia, Louisiana and South Carolina.

Licensed in
GA, LA, SC
In the registry since
2023
Specialties on file
3

Practice location Address checks out

110 Serio Blvd
Ferriday, LA 71334-2013
Phone: (318) 757-8671
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence CP025842A (LA)
Physical Therapy Assistant Taxonomy 225200000X · Licence 4356 (SC)
Physical Therapy Assistant Taxonomy 225200000X · Licence PTA005056 (GA)

Record details

NPI number1740054212
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 14, 2023
Last updated in NPPESNovember 14, 2023
Certification dateNovember 14, 2023

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