Provider Demographics
NPI:1326123712
Name:MILLER, IRVIN (PT)
Entity Type:Individual
Prefix:MR
First Name:IRVIN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 KNIGHTHOOD LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4801
Mailing Address - Country:US
Mailing Address - Phone:410-381-4850
Mailing Address - Fax:410-381-4851
Practice Address - Street 1:6920 KNIGHTHOOD LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4801
Practice Address - Country:US
Practice Address - Phone:410-381-4850
Practice Address - Fax:410-381-4851
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist