1760918932 NPI number — MARK A MILLER PHYSICAL THERAPY LLC

Table of content: (NPI 1760918932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760918932 NPI number — MARK A MILLER PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK A MILLER PHYSICAL THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1760918932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98812-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-689-2260
Provider Business Mailing Address Fax Number:
509-689-8401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
537 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98812-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-689-2226
Provider Business Practice Location Address Fax Number:
509-689-8401
Provider Enumeration Date:
05/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
509-689-2260

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  00002285 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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