Provider Demographics
NPI:1275764938
Name:MILLER, MELISSA RUTH (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RUTH
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 1:5830 N 12TH PL UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2359
Mailing Address - Country:US
Mailing Address - Phone:480-383-3941
Mailing Address - Fax:
Practice Address - Street 1:3411 N 5TH AVE STE 402
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3813
Practice Address - Country:US
Practice Address - Phone:602-264-0443
Practice Address - Fax:602-264-9727
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8547A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant