Individual
LADARIUS MCMILLIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
526 COTTONBROOK CV, SOUTHAVEN, MS 38671-4708
(662) 275-0750
Mailing address
526 COTTONBROOK CV, SOUTHAVEN, MS 38671-4708
(662) 275-0750
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA6525
MS
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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