Provider Demographics
NPI:1619674694
Name:MILLER, MARCILET ANNA (PT)
Entity Type:Individual
Prefix:
First Name:MARCILET
Middle Name:ANNA
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4324 S SHERWOOD FOREST BLVD STE B170
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4481
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-465-8823
Practice Address - Street 1:9808 BLUEBONNET BLVD STE 201
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6442
Practice Address - Country:US
Practice Address - Phone:225-239-5680
Practice Address - Fax:844-315-7631
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist