Provider Demographics
NPI:1801009923
Name:MCMILLAN, JOAN ANITA (PT)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:ANITA
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ANGELA LN
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-2906
Mailing Address - Country:US
Mailing Address - Phone:978-667-8059
Mailing Address - Fax:
Practice Address - Street 1:21 ANGELA LN
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-2906
Practice Address - Country:US
Practice Address - Phone:978-667-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1612OtherMA PT LICENSE