Provider Demographics
NPI:1629325147
Name:MILLS, ENOCH RICHARD (MPT)
Entity Type:Individual
Prefix:MR
First Name:ENOCH
Middle Name:RICHARD
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 1:3605 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2434
Mailing Address - Country:US
Mailing Address - Phone:801-602-6780
Mailing Address - Fax:
Practice Address - Street 1:3605 WESLEY ST
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2434
Practice Address - Country:US
Practice Address - Phone:801-602-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist