Provider Demographics
NPI:1568946531
Name:MILLS, EVAN WRIGHT (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:WRIGHT
Last Name:MILLS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-5516
Mailing Address - Country:US
Mailing Address - Phone:781-894-8880
Mailing Address - Fax:
Practice Address - Street 1:564 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-5516
Practice Address - Country:US
Practice Address - Phone:781-894-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist