Provider Demographics
NPI:1225381643
Name:MILLER WUTZKE, NANCY MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MICHELE
Last Name:MILLER WUTZKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 BYRON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2830
Mailing Address - Country:US
Mailing Address - Phone:360-305-0306
Mailing Address - Fax:
Practice Address - Street 1:4101 BYRON AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-2830
Practice Address - Country:US
Practice Address - Phone:360-305-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00009557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist