Provider Demographics
NPI:1467562900
Name:MILLER, STACI L (PT)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5113 PIPER STATION DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6689
Mailing Address - Country:US
Mailing Address - Phone:980-224-8191
Mailing Address - Fax:980-224-8194
Practice Address - Street 1:5113 PIPER STATION DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6689
Practice Address - Country:US
Practice Address - Phone:980-224-8191
Practice Address - Fax:980-224-8194
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY033085-1225100000X
VT0400003599225100000X
NC11833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11346086OtherCIGNA
11346086OtherGREAT WEST
VT00068157OtherBLUE CROSS BLUE SHIELD
VT1010769Medicaid
373056OtherMVP HEALTHCARE
373056OtherMVP HEALTHCARE