Provider Demographics
NPI:1740389436
Name:MILLER, CONNIE JEAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:JEAN
Other - Last Name:STODDARD-MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:1134 EAST FINCASTLE TURNPIKE
Mailing Address - Street 2:HEARTLAND REHABILITATION SERVICES
Mailing Address - City:NORTH TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24630
Mailing Address - Country:US
Mailing Address - Phone:276-988-0910
Mailing Address - Fax:276-988-0920
Practice Address - Street 1:1134 EAST FINCASTLE TURNPIKE
Practice Address - Street 2:HEARTLAND REHABILITATION SERVICES
Practice Address - City:NORTH TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24630
Practice Address - Country:US
Practice Address - Phone:276-988-0910
Practice Address - Fax:276-988-0920
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist