Provider Demographics
NPI:1235686866
Name:MILLAN, PHILLIP ANTHONY (ATC)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:MILLAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 FENWAY SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8671
Mailing Address - Country:US
Mailing Address - Phone:816-510-6837
Mailing Address - Fax:
Practice Address - Street 1:5425 MCWILLIAMS ROAD
Practice Address - Street 2:BLDG 5425
Practice Address - City:CAMP BULLIS
Practice Address - State:TX
Practice Address - Zip Code:78257
Practice Address - Country:US
Practice Address - Phone:210-295-8337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL45092255A2300X
TXAT77332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer