Provider Demographics
NPI:1134167638
Name:MILLS RIVER PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:MILLS RIVER PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DYLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:828-890-0040
Mailing Address - Street 1:4687 BOYLSTON HWY
Mailing Address - Street 2:
Mailing Address - City:HORSE SHOE
Mailing Address - State:NC
Mailing Address - Zip Code:28742-6731
Mailing Address - Country:US
Mailing Address - Phone:828-890-0040
Mailing Address - Fax:828-890-0530
Practice Address - Street 1:4687 BOYLSTON HWY
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759-6731
Practice Address - Country:US
Practice Address - Phone:828-890-0040
Practice Address - Fax:828-890-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2503987Medicare ID - Type Unspecified