Provider Demographics
NPI:1659330702
Name:MCMILLAN, TRISHA ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:ANNE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SCHOOLCREST
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617
Mailing Address - Country:US
Mailing Address - Phone:989-386-9170
Mailing Address - Fax:989-386-9220
Practice Address - Street 1:107 SCHOOLCREST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617
Practice Address - Country:US
Practice Address - Phone:989-386-9170
Practice Address - Fax:989-386-9220
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist