MEDICARE: PAMELA MILLS PHYSICAL THERAPIST LLC

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
1	261QP2000X	Physical Therapy Clinic/Center	612	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982861142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAMELA MILLS PHYSICAL THERAPIST LLC

Provider Business Mailing Address
First Line	:	128 S WASHINGTON ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2739
Country	:	US
Telephone Number	:	307-265-2461
Fax Number	:	307-265-2492

Provider Business Practice Location Address
First Line	:	128 S WASHINGTON ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2739
Country	:	US
Telephone Number	:	307-265-2461
Fax Number	:	307-265-2492

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PAMELA J MILLS
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	307-265-2461

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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