Provider Demographics
NPI:1467526392
Name:MILLS, PAMELA J (PT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:MILLS
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 1:128 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2739
Mailing Address - Country:US
Mailing Address - Phone:307-265-2461
Mailing Address - Fax:307-265-2492
Practice Address - Street 1:128 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2739
Practice Address - Country:US
Practice Address - Phone:307-265-2461
Practice Address - Fax:307-265-2492
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY02-0736690OtherTAX ID #