Provider Demographics
NPI:1821089061
Name:MILLS, WAYNE M (PT)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:M
Last Name:MILLS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9518 SCORPIO ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-4745
Mailing Address - Country:US
Mailing Address - Phone:208-322-7660
Mailing Address - Fax:208-362-4978
Practice Address - Street 1:40 W FRANKLIN RD
Practice Address - Street 2:C/O COMMUNICARE
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2965
Practice Address - Country:US
Practice Address - Phone:208-861-3648
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT-048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT-0387OtherBLUE CROSS OF IDAHO
IDS38238Medicare UPIN
IDT-0387OtherBLUE CROSS OF IDAHO