Provider Demographics
NPI:1033611769
Name:MCMILLEN, CORY ELIZABETH (MS,LAT,ATC)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:ELIZABETH
Last Name:MCMILLEN
Suffix:
Gender:F
Credentials:MS,LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-2213
Mailing Address - Country:US
Mailing Address - Phone:215-499-6177
Mailing Address - Fax:
Practice Address - Street 1:20 N NEWTOWN STREET RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2319
Practice Address - Country:US
Practice Address - Phone:484-420-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART20059572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000018197OtherATHLETIC TRAINING BOARD OF CERTIFICATION
PART005957OtherPENNSYLVANIA STATE BOARD OF MEDICINE