Provider Demographics
NPI:1730307695
Name:MILLER, ANN ELIZABETH (PT)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 N CHILLICOTHE ST APT A
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-1048
Mailing Address - Country:US
Mailing Address - Phone:614-873-6049
Mailing Address - Fax:
Practice Address - Street 1:234 N CHILLICOTHE ST APT A
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-1048
Practice Address - Country:US
Practice Address - Phone:614-873-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.007213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2491012Medicaid