Provider Demographics
NPI:1164677563
Name:MILLER, YVETTE M (PTA)
Entity Type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:YVETTE
Other - Middle Name:M
Other - Last Name:MARCHETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1720 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-3502
Mailing Address - Country:US
Mailing Address - Phone:847-625-0202
Mailing Address - Fax:847-625-0101
Practice Address - Street 1:1720 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-3502
Practice Address - Country:US
Practice Address - Phone:847-625-0202
Practice Address - Fax:847-625-0101
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-001704225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant