Provider Demographics
NPI:1083388102
Name:MILLER, CAITLYN MARIE (PTA)
Entity Type:Individual
Prefix:MS
First Name:CAITLYN
Middle Name:MARIE
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 1:2510 SMITH POINT RD
Mailing Address - Street 2:
Mailing Address - City:NANJEMOY
Mailing Address - State:MD
Mailing Address - Zip Code:20662-3513
Mailing Address - Country:US
Mailing Address - Phone:240-585-2976
Mailing Address - Fax:
Practice Address - Street 1:3 POST OFFICE RD STE 105
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2756
Practice Address - Country:US
Practice Address - Phone:301-893-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5523225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant