Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1003305962 |
---|---|
Provider Name | Kyle Victor Mills |
First Address | Chugiak, AK 99567-6275 |
Second Address | Palmer, AK 99645-6665 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2018 |
Last Update Date | 07/05/2018 |