Provider Demographics
NPI:1104515725
Name:MILLIKEN, SCOTT (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MILLIKEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7960 E THOMPSON PEAK PKWY STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7406
Practice Address - Country:US
Practice Address - Phone:602-313-4710
Practice Address - Fax:480-222-1457
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206141225100000X
TNCP025049T225100000X
AZLPT-005221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist