MEDICARE: MR. CHRISTOPHER SCOTT MILLS BS, CSCS, LMT

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	225700000X	Massage Therapist	227-003757	IL
2	224Y00000X	Clinical Exercise Physiologist

General Provider Information

NPI Number	:	1730481169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER SCOTT MILLS BS, CSCS, LMT

Provider Business Mailing Address
First Line	:	1752 WINDSOR RD STE 202
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-4276
Country	:	US
Telephone Number	:	815-977-3747
Fax Number	:

Provider Business Practice Location Address
First Line	:	1752 WINDSOR RD STE 202
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-4276
Country	:	US
Telephone Number	:	815-977-3747
Fax Number	:

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

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	09/22/2016

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