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General NPI Number Information
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NPI Number | 1720329428
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Entity Type | Individual
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Provider Name | JAY R MILLS DPT
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Gender | Male
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 2325 CORONADO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7407
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Country | US
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Telephone | 208-557-2800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2018
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City | EVANSTON
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State | WY
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Zip | 82931-2018
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Country | US
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Telephone | 801-540-5545
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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 | 1423
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License Number State | WY
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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 | 8222367-2401
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-4285
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License Number State | ID
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