1740242858 NPI number — MS. MARCIA LOU MILLER MS PT CHT

Table of content: MS. MARCIA LOU MILLER MS PT CHT (NPI 1740242858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740242858 NPI number — MS. MARCIA LOU MILLER MS PT CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
MARCIA
Provider Middle Name:
LOU
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS PT CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740242858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 NEW FIDELITY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-2665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-258-2714
Provider Business Mailing Address Fax Number:
410-648-4878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
156 STRAWBERRY PLAINS RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188-3409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-565-3400
Provider Business Practice Location Address Fax Number:
757-565-6445
Provider Enumeration Date:
04/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305002620 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8928631 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 192939 . This is a "BCBS PHYSICAL THERAPY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 650016244 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5366634 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".