Provider Demographics
NPI:1912653767
Name:MCMILLIAN, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:MCMILLIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:309 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6142
Mailing Address - Country:US
Mailing Address - Phone:979-418-7165
Mailing Address - Fax:800-419-5153
Practice Address - Street 1:309 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6142
Practice Address - Country:US
Practice Address - Phone:979-418-7165
Practice Address - Fax:800-419-5153
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2086720225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant