Provider Demographics
NPI:1326320953
Name:MILLER, KELLY (MPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
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 1:875 E. SILVERADO RANCH BOULEVARD
Mailing Address - Street 2:APT. 2017
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183
Mailing Address - Country:US
Mailing Address - Phone:702-335-1895
Mailing Address - Fax:
Practice Address - Street 1:875 E SILVERADO RANCH BLVD
Practice Address - Street 2:APT. 2017
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-5887
Practice Address - Country:US
Practice Address - Phone:702-335-1895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist