Provider Demographics
NPI:1356692461
Name:MILLS, AMY MARIE (LMT, MT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:MILLS
Suffix:
Gender:F
Credentials:LMT, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2756 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2546
Mailing Address - Country:US
Mailing Address - Phone:954-704-8626
Mailing Address - Fax:
Practice Address - Street 1:2756 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2546
Practice Address - Country:US
Practice Address - Phone:954-704-8626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63828173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist