Provider Demographics
NPI:1619130630
Name:MILLS, ERIC (MPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MILLS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 N PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:314 W SUPERIOR ST
Practice Address - Street 2:LL-E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3538
Practice Address - Country:US
Practice Address - Phone:312-701-4089
Practice Address - Fax:312-291-9726
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-016455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist