Provider Demographics
NPI:1093737835
Name:MILLER, STEPHEN R (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
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 1:1150 WEST WARD STREET EXTENSION
Mailing Address - Street 2:MAGNOLIA PLACE B-1
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-1902
Mailing Address - Country:US
Mailing Address - Phone:912-384-4813
Mailing Address - Fax:912-383-9090
Practice Address - Street 1:1150 WEST WARD STREET EXTENSION
Practice Address - Street 2:MAGNOLIA PLACE B-1
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-1902
Practice Address - Country:US
Practice Address - Phone:912-384-4813
Practice Address - Fax:912-383-9090
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52775003OtherBLUE CROSS BLUE SHIELD OF
GA52775003OtherBLUE CROSS BLUE SHIELD OF