Provider Demographics
NPI:1811019326
Name:MILLARD, TERRIE LEE (PT, DPT, PCS)
Entity Type:Individual
Prefix:DR
First Name:TERRIE
Middle Name:LEE
Last Name:MILLARD
Suffix:
Gender:F
Credentials:PT, DPT, PCS
Other - Prefix:DR
Other - First Name:TERRIE
Other - Middle Name:LEE
Other - Last Name:MILLARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT, PCS
Mailing Address - Street 1:253 MANLEY RD
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-2354
Mailing Address - Country:US
Mailing Address - Phone:678-575-1227
Mailing Address - Fax:
Practice Address - Street 1:634 TOMMY AARON DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-1504
Practice Address - Country:US
Practice Address - Phone:770-503-7337
Practice Address - Fax:770-503-7337
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000578344DMedicaid