Provider Demographics
NPI:1427574037
Name:ROSSI-MILLER, ANTOINETTE MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:MARIE
Last Name:ROSSI-MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WHEATLAND DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-3531
Mailing Address - Country:US
Mailing Address - Phone:540-828-4114
Mailing Address - Fax:
Practice Address - Street 1:302 N 2ND ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-1712
Practice Address - Country:US
Practice Address - Phone:540-828-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001646225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty