MEDICARE: ADAM RUSSELL MILLS PTA

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	5502004352	MI

General Provider Information

NPI Number	:	1639844418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM RUSSELL MILLS PTA

Provider Business Mailing Address
First Line	:	3402 TREMONTE CIR N
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48306-5003
Country	:	US
Telephone Number	:	810-922-7694
Fax Number	:

Provider Business Practice Location Address
First Line	:	3402 TREMONTE CIR N
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48306-5003
Country	:	US
Telephone Number	:	810-922-7694
Fax Number	:

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

Provider Enumeration Date	:	08/12/2021
Last Update Date	:	08/12/2021

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