Provider Demographics
NPI:1780686386
Name:MILLER, SAMUEL (PT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
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 1:807 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1067
Mailing Address - Country:US
Mailing Address - Phone:828-298-5846
Mailing Address - Fax:
Practice Address - Street 1:333 GASHES CREEK RD
Practice Address - Street 2:SUITE A
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-9405
Practice Address - Country:US
Practice Address - Phone:828-299-4636
Practice Address - Fax:828-299-4637
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211691Medicaid
NC7211691Medicaid