Provider Demographics
NPI:1043508005
Name:MILLS, KRISTEN (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3805
Mailing Address - Country:US
Mailing Address - Phone:765-662-9905
Mailing Address - Fax:
Practice Address - Street 1:801 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:IN
Practice Address - Zip Code:46792-9402
Practice Address - Country:US
Practice Address - Phone:260-375-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010617A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist