Provider Demographics
NPI:1720019599
Name:MILLER, SCOTT T (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name: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 1:13331 PARK WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-8494
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6016 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3050
Practice Address - Country:US
Practice Address - Phone:269-329-0934
Practice Address - Fax:269-329-0965
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1720019599OtherNPI
MI650C913290OtherBCBSM
MI1649216144OtherGROUP NPI
MI5501009459OtherSTATE OF MICHIGAN
MI1720019599OtherNPI
MIP4810005Medicare ID - Type UnspecifiedMEDICARE