Provider Demographics
NPI:1174010185
Name:MILLER, JOSHUA D (ATC,LAT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6906
Mailing Address - Country:US
Mailing Address - Phone:410-596-3600
Mailing Address - Fax:
Practice Address - Street 1:10710 CHARTER DR STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3260
Practice Address - Country:US
Practice Address - Phone:410-644-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00008432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer