1619115276 NPI number — TAMSYN NOEL MILLER PHYSICAL THERAPIST

Table of content: TAMSYN NOEL MILLER PHYSICAL THERAPIST (NPI 1619115276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619115276 NPI number — TAMSYN NOEL MILLER PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
TAMSYN
Provider Middle Name:
NOEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
TAMSYN
Provider Other Middle Name:
NOEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619115276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-478-1933
Provider Business Mailing Address Fax Number:
530-478-1937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
569 SEARLS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEVADA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-478-1933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2009

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:  PT35287 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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