Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A3236 | MD |
NPI | 1013489020 |
---|---|
Provider Name | Jennifer Mills |
First Address | Hagerstown, MD 21742-3108 |
Second Address | Hagerstown, MD 21742-3108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2019 |
Last Update Date | 02/01/2019 |