Provider Demographics
NPI:1750828182
Name:MILLAR, MITCHELL (DPT)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:MILLAR
Suffix:
Gender:M
Credentials:DPT
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 AVE
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-1145
Mailing Address - Country:US
Mailing Address - Phone:989-386-9170
Mailing Address - Fax:
Practice Address - Street 1:2600 N SAGINAW RD STE C
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2690
Practice Address - Country:US
Practice Address - Phone:989-837-1529
Practice Address - Fax:989-837-2499
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4606037995022255A2300X
MI5501302556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer