Provider Demographics
NPI:1710959143
Name:SHORT-MILLER, ERIC D (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:D
Last Name:SHORT-MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 BARKLEY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6696
Mailing Address - Country:US
Mailing Address - Phone:360-733-4008
Mailing Address - Fax:360-733-4064
Practice Address - Street 1:2075 BARKLEY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6696
Practice Address - Country:US
Practice Address - Phone:360-733-4008
Practice Address - Fax:360-733-4064
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8327645Medicaid
WA105635OtherLABOR AND INDUSTRY
650020469OtherRR MEDICARE
650020469OtherRR MEDICARE
650020469OtherRR MEDICARE
A004OtherTRICARE