Provider Demographics
NPI:1194749952
Name:MILLS RIVER PHYSICAL THERAPY
Entity type:Organization
Organization Name:MILLS RIVER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DYLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-890-0040
Mailing Address - Street 1:4687 BOYLSTON HWY
Mailing Address - Street 2:
Mailing Address - City:HORSE SHOE
Mailing Address - State:NC
Mailing Address - Zip Code:28742-6731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4687 BOYLSTON HWY
Practice Address - Street 2:
Practice Address - City:HORSE SHOE
Practice Address - State:NC
Practice Address - Zip Code:28742-6731
Practice Address - Country:US
Practice Address - Phone:828-890-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10304261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy