1679098529 NPI number — JANICE C MILLARE RPT

Table of content: JANICE C MILLARE RPT (NPI 1679098529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679098529 NPI number — JANICE C MILLARE RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLARE
Provider First Name:
JANICE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679098529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6847 BROADWATER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33467-8602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-303-4938
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SELECT REHABILITATION, LLC
Provider Second Line Business Practice Location Address:
2600 COMPASS RD
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-787-3430
Provider Business Practice Location Address Fax Number:
847-386-5190
Provider Enumeration Date:
08/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0048 , registered in the state of MP ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT36519 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0048 . This is a "CNMI LICENSING BOARD" identifier , issued by the state of ( MP ) . This identifiers is of the category "OTHER".
  • Identifier: 36519 . This is a "FLORIDA BOARD OF PHYSICAL THERAPY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4814 . This is a "NEW MEXICO PHYSICAL THERAPY BOARD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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