Individual
COREY MILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
9880 BROCKINGTON RD, SUITE 147, SHERWOOD, AR 72120-3585
(501) 944-7819
Mailing address
22 VISTA DR, LITTLE ROCK, AR 72210-1720
(501) 412-3509
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PTA 1244
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1
NA
AR
Enumeration date
02/02/2011
Last updated
02/02/2011
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