Healthcare Provider Details

I. General information

NPI: 1467844027
Provider Name (Legal Business Name): ADAM MILLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CUMBERLAND AVE
MIDDLESBORO KY
40965-2614
US

IV. Provider business mailing address

3600 CUMBERLAND AVE
MIDDLESBORO KY
40965-2614
US

V. Phone/Fax

Practice location:
  • Phone: 606-242-1420
  • Fax: 606-242-1421
Mailing address:
  • Phone: 606-242-1420
  • Fax: 606-242-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA02923
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: