Provider Demographics
NPI:1306096433
Name:MILLARD, DAVID DUANE (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:DUANE
Last Name:MILLARD
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 1:16051 QUALITY COURT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55043
Mailing Address - Country:US
Mailing Address - Phone:651-430-3320
Mailing Address - Fax:
Practice Address - Street 1:16051 QUALITY COURT
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:MN
Practice Address - Zip Code:55043
Practice Address - Country:US
Practice Address - Phone:651-430-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2416225100000X
WI3410-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist