Individual
CORY ELIZABETH MCMILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,LAT,ATC
Contact information
Practice address
20 N NEWTOWN STREET RD, NEWTOWN SQUARE, PA 19073-2319
(484) 420-2680
Mailing address
15 KINGSWOOD DR, NEW HOPE, PA 18938-2213
(215) 499-6177
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT2005957
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000018197
ATHLETIC TRAINING BOARD OF CERTIFICATION
—
01
—
RT005957
PENNSYLVANIA STATE BOARD OF MEDICINE
PA
Enumeration date
03/08/2018
Last updated
03/08/2018
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