Provider Demographics
NPI:1326204215
Name:MILLER, COURTNEY MARIE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:MARIE
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 1:77 WALNUTTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-8327
Mailing Address - Country:US
Mailing Address - Phone:610-944-9797
Mailing Address - Fax:
Practice Address - Street 1:350 S CEDARBROOK RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5708
Practice Address - Country:US
Practice Address - Phone:610-395-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008094225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant