Provider Demographics
NPI:1558304790
Name:MILLER, ROGER J (PT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6464 BORLAND RD
Mailing Address - Street 2:STE B5
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8859
Mailing Address - Country:US
Mailing Address - Phone:971-204-0600
Mailing Address - Fax:971-204-0602
Practice Address - Street 1:6464 SW BORLAND RD STE B5
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8859
Practice Address - Country:US
Practice Address - Phone:971-204-0600
Practice Address - Fax:971-204-0602
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPT0851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR103955Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER