Provider Demographics
NPI:1013657535
Name:MILLS, MELISSA ERIN (ACSM-CEP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ERIN
Last Name:MILLS
Suffix:
Gender:F
Credentials:ACSM-CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6596 FELLINGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8614
Mailing Address - Country:US
Mailing Address - Phone:301-514-6895
Mailing Address - Fax:
Practice Address - Street 1:15201 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3217
Practice Address - Country:US
Practice Address - Phone:301-948-4395
Practice Address - Fax:301-407-1860
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Multi-Specialty