Provider Demographics
NPI:1710647144
Name:MILLER, RICHARD JOSEPH TOWNSEND (DPT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH TOWNSEND
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 STUCKY RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-9030
Mailing Address - Country:US
Mailing Address - Phone:808-756-5437
Mailing Address - Fax:
Practice Address - Street 1:3645 STUCKY RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9030
Practice Address - Country:US
Practice Address - Phone:808-756-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-LIC-19574225100000X
ORCP008901T225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist