Provider Demographics
NPI:1043202625
Name:MILLER, HOLLY MICHELLE FORSTER
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MICHELLE FORSTER
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:MICHELLE
Other - Last Name:FORSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1201 TERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2735
Mailing Address - Country:US
Mailing Address - Phone:206-223-7528
Mailing Address - Fax:206-223-7577
Practice Address - Street 1:1201 TERRY AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2735
Practice Address - Country:US
Practice Address - Phone:206-223-7528
Practice Address - Fax:206-223-7577
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA650024223OtherR/R MED PIERCE CNTY
WA2192FOOtherREGENCE BS
WA650025726OtherR/R MEDICARE
WA8342636Medicaid
WA9058FOOtherBLUE SHIELD # VM
WAUS7533340OtherAETNA PCP PIN VM
WA069741OtherGROUP HEALTH # VM
WA157609OtherDEPT OF L&I
WA8936256OtherCRIME VICTIMS
WAUS7533340OtherAETNA PCP PIN VM
WAAB27229Medicare PIN
WA9058FOOtherBLUE SHIELD # VM