Provider Demographics
NPI:1720211121
Name:MILLS, MARY (CMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875-0159
Mailing Address - Country:US
Mailing Address - Phone:406-369-0735
Mailing Address - Fax:
Practice Address - Street 1:105 RAVALLI ST
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2437
Practice Address - Country:US
Practice Address - Phone:406-369-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist