Provider Demographics
NPI:1346629854
Name:MILLS, TERESA R (LMT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:R
Last Name:MILLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-5634
Mailing Address - Country:US
Mailing Address - Phone:304-640-2853
Mailing Address - Fax:
Practice Address - Street 1:514 JONES AVE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2954
Practice Address - Country:US
Practice Address - Phone:304-465-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2005-1879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist