Provider Demographics
NPI:1184456824
Name:MILLIGAN, KEVIN JOHN (PTA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15841 MIRASOL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-2135
Mailing Address - Country:US
Mailing Address - Phone:508-410-0081
Mailing Address - Fax:
Practice Address - Street 1:725 S INTERSTATE 35 E STE 188
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-8154
Practice Address - Country:US
Practice Address - Phone:940-222-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2158558225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant