Provider Demographics
NPI:1275170789
Name:MILLARD, ANGELA M (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:MILLARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 OTTER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GLENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13343-2013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7785 N. STATE STREET
Practice Address - Street 2:REHAB DEPARTMENT
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1334
Practice Address - Country:US
Practice Address - Phone:315-376-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist