Provider Demographics
NPI:1306025929
Name:MILLER, MELISSA L (MPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 GLANZMAN RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3856
Mailing Address - Country:US
Mailing Address - Phone:419-382-8141
Mailing Address - Fax:419-382-7081
Practice Address - Street 1:7141 SPRING MEADOWS DR W
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9295
Practice Address - Country:US
Practice Address - Phone:419-865-9425
Practice Address - Fax:419-865-9457
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-01187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist