Provider Demographics
NPI:1417363995
Name:MILLWOOD, PAUL (LMT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:MILLWOOD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 LOCUST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4415
Mailing Address - Country:US
Mailing Address - Phone:610-348-7840
Mailing Address - Fax:
Practice Address - Street 1:1530 LOCUST ST
Practice Address - Street 2:SUITE C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4415
Practice Address - Country:US
Practice Address - Phone:610-348-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG008614173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist