Provider Demographics
NPI:1407879364
Name:MILLER, CAROLYN DIANE (PT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DIANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 SUNNY ACRES RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-7428
Mailing Address - Country:US
Mailing Address - Phone:423-753-2201
Mailing Address - Fax:
Practice Address - Street 1:JAMES H QUILLEN/VAMC
Practice Address - Street 2:CORDER OF SIDNEY AND LAMONT
Practice Address - City:MOUNTAIN HOME,
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000000943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist