Provider Demographics
NPI:1992964753
Name:MILLARD, NANCY STUDTMAN (PT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:STUDTMAN
Last Name:MILLARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:STUDTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5610 NORWICH PKWY
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082
Mailing Address - Country:US
Mailing Address - Phone:651-275-5745
Mailing Address - Fax:651-275-5775
Practice Address - Street 1:5610 NORWICH PKWY
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082
Practice Address - Country:US
Practice Address - Phone:651-275-5745
Practice Address - Fax:651-275-5775
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2426225100000X
WI2662024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40250600Medicaid