NPIMap

Individual provider Active NPI

Christina Marie Clark Mills, PHYSICAL THERAPIST

  • Physical Therapist
  • Lafayette, LA
National Provider Identifier
1043354723
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
07123 Issued in LA
Practice address
709 Kaliste Saloom Rd
Lafayette, LA 70508-4207
Phone
(337) 234-7018
Fax
(337) 234-7061
NPI assigned
Feb 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 07123 LA Primary

Addresses

Primary practice location

709 Kaliste Saloom Rd
Lafayette, LA 70508-4207

Mailing address

509 Walter Dr
Lafayette, LA 70507-2462
Phone (337) 886-6873

Other names 1

  • Christina Marie Clark Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
07123LAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Dynamic Physical Therapy Services PC Physical Therapist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043354723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 WALTER DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705072462",
            "telephone_number": "337-886-6873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 KALISTE SALOOM RD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705084207",
            "telephone_number": "337-234-7018",
            "fax_number": "337-234-7061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK MILLS",
        "first_name": "CHRISTINA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "07123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINA",
            "last_name": "CLARK",
            "middle_name": "MARIE",
            "credential": "PHYSICAL THERAPIST",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.