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NPI Code Detail

MEDICARE: SAMANTHA MILLS

MEDICARE: SAMANTHA MILLS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer2000005067VA

General Provider Information

NPI Number : 1689051617
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA MILLS
Provider Business Mailing Address
First Line : 3026 FAIRMONT ST
Second Line :
City : FALLS CHURCH
State : VA
Zip : 22042-1309
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3026 FAIRMONT ST
Second Line :
City : FALLS CHURCH
State : VA
Zip : 22042-1309
Country : US
Telephone Number : 571-213-5852
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2015
Last Update Date : 04/28/2015

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Directions to “ SAMANTHA MILLS ” Practice Location

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