Healthcare Provider Details

I. General information

NPI: 1346394160
Provider Name (Legal Business Name): LISSA DONELL MILLS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N CENTRAL EXPY STE 110
RICHARDSON TX
75080-2718
US

IV. Provider business mailing address

3115 STATE ST APT 1011
DALLAS TX
75204-3519
US

V. Phone/Fax

Practice location:
  • Phone: 214-265-1819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1151470
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: