MEDICARE: GREGORY JOHN MILLS DPT

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	225100000X	Physical Therapist	PT5953	ME

General Provider Information

NPI Number	:	1417521022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY JOHN MILLS DPT

Provider Business Mailing Address
First Line	:	100 GANNETT DRIVE
Second Line	:	SUITE C
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106
Country	:	US
Telephone Number	:	207-347-2947
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 FODEN ROAD
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106
Country	:	US
Telephone Number	:	207-780-8860
Fax Number	:

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

Provider Enumeration Date	:	05/18/2021
Last Update Date	:	04/16/2026

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