Provider Demographics
NPI:1609834183
Name:MILLER, PAUL GORDON GUY (ATC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:GORDON GUY
Last Name:MILLER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7796 HOLDERMAN ST
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-6003
Mailing Address - Country:US
Mailing Address - Phone:614-337-3737
Mailing Address - Fax:
Practice Address - Street 1:140 HAMILTON RD
Practice Address - Street 2:AT ROOM
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230
Practice Address - Country:US
Practice Address - Phone:614-413-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-1892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer