1891092680 NPI number — MRS. SUSAN K MILLER LPTA

Table of content: MRS. SUSAN K MILLER LPTA (NPI 1891092680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891092680 NPI number — MRS. SUSAN K MILLER LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
SUSAN
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUNNINGHAM
Provider Other First Name:
SUSAN
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891092680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
626 E BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST POINT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39773-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-295-6973
Provider Business Mailing Address Fax Number:
662-494-2006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
804 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST POINT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39773-3137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-295-6973
Provider Business Practice Location Address Fax Number:
662-494-2006
Provider Enumeration Date:
02/14/2011

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: 225200000X , with the licence number:  PTA2962 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PTA2962 . This is a "MISSISSIPPI STATE BOARD OF PHYSICAL THERAPY" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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