Healthcare Provider Details

I. General information

NPI: 1144831827
Provider Name (Legal Business Name): BRIANNA N MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 W LINCOLN HWY LOWR LEVEL
CROWN POINT IN
46307-9678
US

IV. Provider business mailing address

6625 W LINCOLN HWY LOWR LEVEL
CROWN POINT IN
46307-9678
US

V. Phone/Fax

Practice location:
  • Phone: 219-440-5360
  • Fax:
Mailing address:
  • Phone: 219-440-5360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06006080A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: