Provider Demographics
NPI:1063667343
Name:MILLS, JAMIE LEE (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:LEE
Last Name:MILLS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:BAHRUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 DELAFIELD ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1749
Mailing Address - Country:US
Mailing Address - Phone:845-431-8803
Mailing Address - Fax:845-462-0081
Practice Address - Street 1:241 NORTH ROAD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-431-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026818-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist