Provider Demographics
NPI:1023037389
Name:MILLER, SEAN A (MPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5089 W HERRIMAN BLVD STE 2B
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-2599
Mailing Address - Country:US
Mailing Address - Phone:480-206-1591
Mailing Address - Fax:
Practice Address - Street 1:5089 W HERRIMAN BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-2599
Practice Address - Country:US
Practice Address - Phone:480-206-1591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5687225100000X
UT12298619-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist