Provider Demographics
NPI:1255402475
Name:MILLS, MARIBETH ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:ANNE
Last Name:MILLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARIBETH
Other - Middle Name:ANNE
Other - Last Name:SODL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:517 CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5783
Mailing Address - Country:US
Mailing Address - Phone:814-943-3737
Mailing Address - Fax:
Practice Address - Street 1:1798 OLD ROUTE 220 N
Practice Address - Street 2:SUITE 103
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8341
Practice Address - Country:US
Practice Address - Phone:814-696-3400
Practice Address - Fax:814-696-3402
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006129L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist