Provider Demographics
NPI:1225592207
Name:MILLER, MAGGIE JO (PTA)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 COUNTY ROAD U
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NE
Mailing Address - Zip Code:68038-4582
Mailing Address - Country:US
Mailing Address - Phone:402-870-0193
Mailing Address - Fax:
Practice Address - Street 1:930 2ND ST
Practice Address - Street 2:
Practice Address - City:DODGE
Practice Address - State:NE
Practice Address - Zip Code:68633-3555
Practice Address - Country:US
Practice Address - Phone:402-693-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE694225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant