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General NPI Number Information
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NPI Number | 1699471417
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Entity Type | Individual
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Provider Name | MIKE MILLS LMT
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Gender | Male
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 3307 BOB WALLACE AVE SW STE 1
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City | HUNTSVILLE
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State | AL
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Zip | 35805-4066
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Country | US
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Telephone | 246-425-5337
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Fax |
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Provider Business Mailing Address
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Address Line | 7623 ASHOR DR NW
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City | HUNTSVILLE
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State | AL
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Zip | 35806-1337
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Country | US
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Telephone | 256-425-5337
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 5274
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License Number State | AL
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