Provider Demographics
NPI:1710177134
Name:AUTH, KRISANE MILLER (DPT, CFMM, ATC)
Entity Type:Individual
Prefix:DR
First Name:KRISANE
Middle Name:MILLER
Last Name:AUTH
Suffix:
Gender:F
Credentials:DPT, CFMM, ATC
Other - Prefix:
Other - First Name:KRISANE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC
Mailing Address - Street 1:870 N MILITARY HWY
Mailing Address - Street 2:SUITE 224
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3638
Mailing Address - Country:US
Mailing Address - Phone:757-777-4565
Mailing Address - Fax:
Practice Address - Street 1:870 N MILITARY HWY, SUITE 224
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3638
Practice Address - Country:US
Practice Address - Phone:757-777-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710177134Medicaid
VA192967OtherBCBS (PHYSICAL THERAPY)
VAC05954Medicare PIN
VAVAA104124Medicare PIN