Provider Demographics
NPI:1598831943
Name:MILLER, ANTHONY PHILLIP (MPT MS ATC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:PHILLIP
Last Name:MILLER
Suffix:
Gender:M
Credentials:MPT MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S POLK ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2474
Mailing Address - Country:US
Mailing Address - Phone:985-809-9088
Mailing Address - Fax:985-809-9270
Practice Address - Street 1:1010 S POLK ST
Practice Address - Street 2:SUITE 2
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2474
Practice Address - Country:US
Practice Address - Phone:985-809-9088
Practice Address - Fax:985-809-9270
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06520R2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4C986Medicare ID - Type Unspecified