Provider Demographics
NPI:1508058264
Name:MCMILLAN, COREY M (PT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:M
Last Name:MCMILLAN
Suffix:
Gender:M
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:PO BOX 830633
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0633
Mailing Address - Country:US
Mailing Address - Phone:205-838-3900
Mailing Address - Fax:205-838-3906
Practice Address - Street 1:52 MEDICAL PARK DR E
Practice Address - Street 2:SUITE 115
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3430
Practice Address - Country:US
Practice Address - Phone:205-838-3900
Practice Address - Fax:205-838-3906
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-42956OtherBC BS OF AL