Healthcare Provider Details

I. General information

NPI: 1316717226
Provider Name (Legal Business Name): CHRISTOPHER MILLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 LOWER SHILOH WAY
MORRISVILLE NC
27560-5493
US

IV. Provider business mailing address

602 S WEST ST
RALEIGH NC
27601-2144
US

V. Phone/Fax

Practice location:
  • Phone: 919-377-2084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberP22327
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: