Basic Information
| Provider Information | |||||||||
| NPI: | 1134167638 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILLS RIVER PHYSICAL THERAPY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4687 BOYLSTON HWY | ||||||||
| Address2: | |||||||||
| City: | HORSE SHOE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287426731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288900040 | ||||||||
| FaxNumber: | 8288900530 | ||||||||
| Practice Location | |||||||||
| Address1: | 4687 BOYLSTON HWY | ||||||||
| Address2: | |||||||||
| City: | MILLS RIVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287596731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288900040 | ||||||||
| FaxNumber: | 8288900530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 09/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | DYLEWSKI | ||||||||
| AuthorizedOfficialFirstName: | LACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8288900040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 5314 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.