Provider Demographics
NPI:1669108171
Name:MCMILLAN, JOSIE DIANE (MMT)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:DIANE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 N CURTIS AVE
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751-3817
Mailing Address - Country:US
Mailing Address - Phone:479-451-9200
Mailing Address - Fax:
Practice Address - Street 1:522 N CURTIS AVE
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-3817
Practice Address - Country:US
Practice Address - Phone:479-451-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021010315225700000X
AR7729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist