Provider Demographics
NPI:1740644640
Name:MILLS, LAURIE JEAN (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:JEAN
Last Name:MILLS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:JEAN
Other - Last Name:DASHNAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:701 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-1500
Mailing Address - Country:US
Mailing Address - Phone:315-363-9281
Mailing Address - Fax:315-363-9286
Practice Address - Street 1:7 MORRILL PL
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1530
Practice Address - Country:US
Practice Address - Phone:315-363-3389
Practice Address - Fax:315-363-9286
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0092277-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist