Provider Demographics
NPI:1467562835
Name:MILLS, JENEFER DELICA (BSPT)
Entity Type:Individual
Prefix:
First Name:JENEFER
Middle Name:DELICA
Last Name:MILLS
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27500 102ND AVE NW
Mailing Address - Street 2:STE 1
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8092
Mailing Address - Country:US
Mailing Address - Phone:360-629-9768
Mailing Address - Fax:360-629-7632
Practice Address - Street 1:3405 172ND ST NE
Practice Address - Street 2:STE 10
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7717
Practice Address - Country:US
Practice Address - Phone:360-651-8880
Practice Address - Fax:360-651-9975
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8862279Medicare PIN