Provider Demographics
NPI:1376905075
Name:MILLER, KATIE NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:NICOLE
Other - Last Name:SEIDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14222 VANE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68142-2140
Mailing Address - Country:US
Mailing Address - Phone:402-960-1225
Mailing Address - Fax:
Practice Address - Street 1:6901 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1709
Practice Address - Country:US
Practice Address - Phone:402-572-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist