Basic Information
| Provider Information | |||||||||
| NPI: | 1194749952 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILLS RIVER PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4687 BOYLSTON HWY | ||||||||
| Address2: | |||||||||
| City: | HORSE SHOE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287426731 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 4687 BOYLSTON HWY | ||||||||
| Address2: | |||||||||
| City: | HORSE SHOE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287426731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288900040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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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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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 10304 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.