Provider Demographics
NPI:1215546593
Name:MILLS, THEODORE ROSS (DPT)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:ROSS
Last Name:MILLS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12581 MILSTEAD WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5446
Mailing Address - Country:US
Mailing Address - Phone:703-763-3922
Mailing Address - Fax:703-763-3927
Practice Address - Street 1:12581 MILSTEAD WAY STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5446
Practice Address - Country:US
Practice Address - Phone:703-763-3922
Practice Address - Fax:703-763-3927
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist