Provider Demographics
NPI:1730706359
Name:MILLS, AUDREY (PT, DPT)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
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 1:2753 SUN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-7025
Mailing Address - Country:US
Mailing Address - Phone:636-484-3727
Mailing Address - Fax:
Practice Address - Street 1:8601 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1957
Practice Address - Country:US
Practice Address - Phone:636-484-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020016677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist