Provider Demographics
NPI:1689927121
Name:MILLER, MARILYN E (DPT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 E PARK AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3988
Mailing Address - Country:US
Mailing Address - Phone:619-334-4294
Mailing Address - Fax:619-334-4296
Practice Address - Street 1:353 E PARK AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3988
Practice Address - Country:US
Practice Address - Phone:619-334-4294
Practice Address - Fax:619-334-4296
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist