Provider Demographics
NPI:1578210902
Name:MILLIKAN, MATTIE A (DPT)
Entity Type:Individual
Prefix:MISS
First Name:MATTIE
Middle Name:A
Last Name:MILLIKAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 JENKS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5469
Mailing Address - Country:US
Mailing Address - Phone:850-248-1600
Mailing Address - Fax:
Practice Address - Street 1:2300 JENKS AVE STE C
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-5469
Practice Address - Country:US
Practice Address - Phone:850-248-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist