Provider Demographics
NPI:1003262528
Name:MILLS, ASA CEDRIC (PT)
Entity type:Individual
Prefix:DR
First Name:ASA
Middle Name:CEDRIC
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 1:2061 WILLOW GLEN RD
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-9713
Mailing Address - Country:US
Mailing Address - Phone:786-897-5401
Mailing Address - Fax:
Practice Address - Street 1:31309 TEMECULA PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6826
Practice Address - Country:US
Practice Address - Phone:951-302-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA39290OtherCALIFORNIA PHYSICAL THERAPY BOARD