Provider Demographics
NPI:1235402769
Name:MILLER, STEPHANIE NICOLE AGUERO (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE AGUERO
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:NICOLE
Other - Last Name:AGUERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2057 MISSISSIPPI VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-8326
Mailing Address - Country:US
Mailing Address - Phone:563-260-6018
Mailing Address - Fax:
Practice Address - Street 1:2057 MISSISSIPPI VIEW DR
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-8326
Practice Address - Country:US
Practice Address - Phone:563-260-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist