Provider Demographics
NPI:1518072131
Name:MILLER, THOMAS M (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 N CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9405
Mailing Address - Country:US
Mailing Address - Phone:208-874-2368
Mailing Address - Fax:
Practice Address - Street 1:860 N CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9405
Practice Address - Country:US
Practice Address - Phone:208-874-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-4086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK24459Medicare ID - Type Unspecified