MEDICARE: CAROL ANN MILLINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	3274-19	WI

General Provider Information

NPI Number	:	1184345688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL ANN MILLINGTON

Provider Business Mailing Address
First Line	:	1506 62ND ST
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53143-4474
Country	:	US
Telephone Number	:	262-914-7961
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 8TH AVE
Second Line	:
City	:	UNION GROVE
State	:	WI
Zip	:	53182-1063
Country	:	US
Telephone Number	:	262-878-2788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	09/05/2022

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Directions to “ CAROL ANN MILLINGTON ” Practice Location

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