Provider Demographics
NPI:1447532775
Name:MILLS, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16255 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1587
Mailing Address - Country:US
Mailing Address - Phone:480-998-2120
Mailing Address - Fax:480-998-2126
Practice Address - Street 1:16255 N SCOTTSDALE RD
Practice Address - Street 2:SUITE C-5
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1587
Practice Address - Country:US
Practice Address - Phone:480-998-2120
Practice Address - Fax:480-998-2126
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-14530225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist