Provider Demographics
NPI:1134499270
Name:MILLER, DIANA (ATC/L)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 45TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3958
Mailing Address - Country:US
Mailing Address - Phone:219-924-7316
Mailing Address - Fax:
Practice Address - Street 1:1950 45TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3958
Practice Address - Country:US
Practice Address - Phone:219-924-7316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001717A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer