Provider Demographics
NPI:1700155967
Name:MILLS, MAGNOLIA DELA CRUZ (PT, MPT, DPT)
Entity Type:Individual
Prefix:
First Name:MAGNOLIA
Middle Name:DELA CRUZ
Last Name:MILLS
Suffix:
Gender:F
Credentials:PT, MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3494 CAMINO TASSAJARA # 1016
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4680
Mailing Address - Country:US
Mailing Address - Phone:925-272-8547
Mailing Address - Fax:
Practice Address - Street 1:200 LOWELL CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-5464
Practice Address - Country:US
Practice Address - Phone:915-920-6883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12120762251P0200X
CA387952251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics