Provider Demographics
NPI:1033235825
Name:MILLER, KATHRYN E (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:E
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:427 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3128
Mailing Address - Country:US
Mailing Address - Phone:563-505-4524
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MCADENVILLE
Practice Address - State:NC
Practice Address - Zip Code:28101
Practice Address - Country:US
Practice Address - Phone:704-560-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-015624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-015624OtherILLINOIS PT LICENSE