Provider Demographics
NPI:1437269131
Name:MILLWATER, JOAN (CHT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MILLWATER
Suffix:
Gender:F
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10555 CULEBRA RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3666
Mailing Address - Country:US
Mailing Address - Phone:210-888-6042
Mailing Address - Fax:210-888-6045
Practice Address - Street 1:10555 CULEBRA RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3666
Practice Address - Country:US
Practice Address - Phone:210-888-6042
Practice Address - Fax:210-888-6045
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103597225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103597OtherLICENSE #