Provider Demographics
NPI:1376662577
Name:MILLER, JOHN KENNETH (MS,PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KENNETH
Last Name:MILLER
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 E BELAIR DR
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2580
Mailing Address - Country:US
Mailing Address - Phone:509-765-8919
Mailing Address - Fax:
Practice Address - Street 1:200 NAT WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1997
Practice Address - Country:US
Practice Address - Phone:509-754-4631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist