Provider Demographics
NPI:1013034107
Name:MILLER, CORRY LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CORRY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 GENERAL MCCLELLAN CT
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-3124
Mailing Address - Country:US
Mailing Address - Phone:304-724-1101
Mailing Address - Fax:
Practice Address - Street 1:70 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1170
Practice Address - Country:US
Practice Address - Phone:304-724-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601557225200000X
WV001003225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant