Provider Demographics
NPI:1083709687
Name:MILLER, JOHN K (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:K
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 7TH ST. S.E.
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1105
Mailing Address - Country:US
Mailing Address - Phone:253-848-2309
Mailing Address - Fax:253-848-8407
Practice Address - Street 1:2520 7TH ST. S.E.
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1105
Practice Address - Country:US
Practice Address - Phone:253-848-2309
Practice Address - Fax:253-848-8407
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7206204Medicaid
WAMI1539OtherREGENCE PROVIDER NUMBER
WA7206204Medicaid