Provider Demographics
NPI:1346404936
Name:MILLER, SHELBY PAIGE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:PAIGE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:PAIGE
Other - Last Name:ARCHINAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CI
Mailing Address - Street 1:3060 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5246
Mailing Address - Country:US
Mailing Address - Phone:910-346-3151
Mailing Address - Fax:
Practice Address - Street 1:3060 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5246
Practice Address - Country:US
Practice Address - Phone:910-346-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4538225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant