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NPI Code Detail

MEDICARE: JASON D. MCMILLEN PHYSICAL THERAPIST

MEDICARE: JASON D. MCMILLEN PHYSICAL THERAPIST
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
1225100000XPhysical Therapist7981NC

General Provider Information

NPI Number : 1861462202
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON D. MCMILLEN PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 250 WOOD RD
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21402-1257
Country : US
Telephone Number : 410-293-4378
Fax Number :
Provider Business Practice Location Address
First Line : 250 WOOD RD
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21402-1257
Country : US
Telephone Number : 410-293-4378
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 07/08/2007

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