Basic Information
| Provider Information | |||||||||
| NPI: | 1104225564 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6825 E TENNESSEE AVE | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802241628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038721980 | ||||||||
| FaxNumber: | 3036955013 | ||||||||
| Practice Location | |||||||||
| Address1: | 6825 E TENNESSEE AVE | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802241628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038721980 | ||||||||
| FaxNumber: | 3036955013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2014 | ||||||||
| LastUpdateDate: | 03/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTL.0013103 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT29629 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.