Provider Demographics
NPI:1760918932
Name:MARK A MILLER PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MARK A MILLER PHYSICAL THERAPY LLC
Other - Org Name:MARK A MILLER PHYSICAL THERAPY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-689-2260
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812-1200
Mailing Address - Country:US
Mailing Address - Phone:509-689-2260
Mailing Address - Fax:509-689-8401
Practice Address - Street 1:537 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812-1200
Practice Address - Country:US
Practice Address - Phone:509-689-2226
Practice Address - Fax:509-689-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1760918932Medicare UPIN