Provider Demographics
NPI:1740270842
Name:MCMILLEN, JAMES S (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:MCMILLEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:174 CURRIE HALL PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4387
Mailing Address - Country:US
Mailing Address - Phone:330-548-0080
Mailing Address - Fax:330-548-0088
Practice Address - Street 1:65 COMMUNITY RD
Practice Address - Street 2:SUITE F
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2357
Practice Address - Country:US
Practice Address - Phone:330-633-3680
Practice Address - Fax:330-633-3675
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHPT10203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT10203OtherOHIO, OT, PT, ATC BOARD
OH4200892Medicare PIN