Healthcare Provider Details

I. General information

NPI: 1750828182
Provider Name (Legal Business Name): MITCHELL MILLAR DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N SAGINAW RD STE C
MIDLAND MI
48640-2690
US

IV. Provider business mailing address

107 SCHOOLCREST AVE
CLARE MI
48617-1145
US

V. Phone/Fax

Practice location:
  • Phone: 989-837-1529
  • Fax: 989-837-2499
Mailing address:
  • Phone: 989-386-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number460603799502
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302556
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: