Provider Demographics
NPI:1083740971
Name:MILLER, AMY BETH MARIE (PT)
Entity Type:Individual
Prefix:
First Name:AMY BETH
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CALIAS DR
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7434
Mailing Address - Country:US
Mailing Address - Phone:505-400-6322
Mailing Address - Fax:
Practice Address - Street 1:12127 B-3 NORTH HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008
Practice Address - Country:US
Practice Address - Phone:505-286-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist