Provider Demographics
NPI:1780442665
Name:MILLS, STEPHANIE NICOLE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:MILLS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 GARDENIA CT
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1512
Mailing Address - Country:US
Mailing Address - Phone:760-470-2001
Mailing Address - Fax:
Practice Address - Street 1:980 GARDENIA CT
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1512
Practice Address - Country:US
Practice Address - Phone:760-470-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist