Provider Demographics
NPI:1639844418
Name:MILLS, ADAM RUSSELL (PTA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:RUSSELL
Last Name:MILLS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 TREMONTE CIR N
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-5003
Mailing Address - Country:US
Mailing Address - Phone:810-922-7694
Mailing Address - Fax:
Practice Address - Street 1:3402 TREMONTE CIR N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-5003
Practice Address - Country:US
Practice Address - Phone:810-922-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004352225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant