1801952353 NPI number — AMY CHRISTINE MILLER PT

Table of content: AMY CHRISTINE MILLER PT (NPI 1801952353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801952353 NPI number — AMY CHRISTINE MILLER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
AMY
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1801952353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 MARTINDALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBURNE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05482-6714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-318-7323
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 MALLETTS BAY AVE
Provider Second Line Business Practice Location Address:
AQUATIC REHABILITATION
Provider Business Practice Location Address City Name:
WINOOSKI
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05404-1959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-847-0080
Provider Business Practice Location Address Fax Number:
802-847-0310
Provider Enumeration Date:
12/29/2006

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:  040-0003540 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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