Provider Demographics
NPI:1073794129
Name:MILLER, ANNA L (PTA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:L
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 1:42796 WASHINGTON ST
Mailing Address - Street 2:#1
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-3616
Mailing Address - Country:US
Mailing Address - Phone:760-899-6296
Mailing Address - Fax:
Practice Address - Street 1:72201 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4001
Practice Address - Country:US
Practice Address - Phone:760-340-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 6233225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant