Healthcare Provider Details

I. General information

NPI: 1306970991
Provider Name (Legal Business Name): REBECCA S MCMILLAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BLUEMOUND RD
WAUKESHA WI
53186-2787
US

IV. Provider business mailing address

N87W28518 SCOTT LN
HARTLAND WI
53029-9078
US

V. Phone/Fax

Practice location:
  • Phone: 262-896-3446
  • Fax:
Mailing address:
  • Phone: 414-217-5836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number2451-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: