Healthcare Provider Details

I. General information

NPI: 1598898306
Provider Name (Legal Business Name): DAVID MILLS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5481 SW 60TH ST
OCALA FL
34474-7698
US

IV. Provider business mailing address

5481 SW 60TH ST
OCALA FL
34474-7698
US

V. Phone/Fax

Practice location:
  • Phone: 352-873-1122
  • Fax: 352-873-6841
Mailing address:
  • Phone: 352-873-1122
  • Fax: 352-873-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA19573
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: