Provider Demographics
NPI:1104280577
Name:MILLIKAN, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MILLIKAN
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 1:2805 E OLD CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-9660
Mailing Address - Country:US
Mailing Address - Phone:217-480-0828
Mailing Address - Fax:
Practice Address - Street 1:2304 COUNTY ROAD 3000 N
Practice Address - Street 2:
Practice Address - City:GIFFORD
Practice Address - State:IL
Practice Address - Zip Code:61847-9756
Practice Address - Country:US
Practice Address - Phone:217-568-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist