Provider Demographics
NPI:1093471625
Name:MILLER, SYDNEE RAQUEL (LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:SYDNEE
Middle Name:RAQUEL
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N BROAD ST APT 821
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-5163
Mailing Address - Country:US
Mailing Address - Phone:734-777-8460
Mailing Address - Fax:
Practice Address - Street 1:1101 W MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-2715
Practice Address - Country:US
Practice Address - Phone:215-204-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0078912255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PART007891OtherBUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRES