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General NPI Number Information
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NPI Number | 1306096433
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Entity Type | Individual
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Provider Name | DAVID DUANE MILLARD P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 16051 QUALITY COURT
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City | LAKELAND
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State | MN
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Zip | 55043
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Country | US
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Telephone | 651-430-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 16051 QUALITY COURT
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City | LAKELAND
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State | MN
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Zip | 55043
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Country | US
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Telephone | 651-430-3320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2416
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3410-024
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License Number State | WI
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