Provider Demographics
NPI:1033253604
Name:MILLER, LINDA T (PT DPT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:T
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 W ORMOND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3041
Mailing Address - Country:US
Mailing Address - Phone:856-429-8200
Mailing Address - Fax:856-429-2260
Practice Address - Street 1:13 W ORMOND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3041
Practice Address - Country:US
Practice Address - Phone:856-429-8200
Practice Address - Fax:856-429-2260
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00667300225100000X
PAPT006405L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA549682OtherAETNA PROVIDER NUMBER
PA232681249OtherTAX INDENTIFICATION
PA232681249OtherTAX INDENTIFICATION
PA549682OtherAETNA PROVIDER NUMBER