Provider Demographics
NPI:1598788713
Name:MILLER, AMY LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
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 1:760 N EUCLID ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4133
Mailing Address - Country:US
Mailing Address - Phone:714-535-7700
Mailing Address - Fax:714-535-5445
Practice Address - Street 1:760 N EUCLID ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4133
Practice Address - Country:US
Practice Address - Phone:714-535-7700
Practice Address - Fax:714-535-5445
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 9500261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT 9500Medicare ID - Type Unspecified