Provider Demographics
NPI:1679633473
Name:MILLER, GRACE GANUELAS (LPT)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:GANUELAS
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 SAMUELL BLVD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1027
Mailing Address - Country:US
Mailing Address - Phone:214-328-1400
Mailing Address - Fax:214-328-2884
Practice Address - Street 1:4928 SAMUELL BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1027
Practice Address - Country:US
Practice Address - Phone:214-328-1400
Practice Address - Fax:214-328-2884
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1001OtherBCBS PROVIDER #