1740644640 NPI number — MRS. LAURIE JEAN MILLS PT, DPT

Table of content: MRS. LAURIE JEAN MILLS PT, DPT (NPI 1740644640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740644640 NPI number — MRS. LAURIE JEAN MILLS PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLS
Provider First Name:
LAURIE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DASHNAU
Provider Other First Name:
LAURIE
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740644640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 LENOX AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONEIDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13421-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-363-9281
Provider Business Mailing Address Fax Number:
315-363-9286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 MORRILL PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13069-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-363-3389
Provider Business Practice Location Address Fax Number:
315-363-9286
Provider Enumeration Date:
04/07/2016

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:  0092277-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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