Provider Demographics
NPI:1225567837
Name:MCMILLAN, PETER TROY (DPT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:TROY
Last Name:MCMILLAN
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 1:1122 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6227
Mailing Address - Country:US
Mailing Address - Phone:541-250-4525
Mailing Address - Fax:541-250-4570
Practice Address - Street 1:1122 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6227
Practice Address - Country:US
Practice Address - Phone:541-250-4525
Practice Address - Fax:541-250-4570
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist