Provider Demographics
NPI:1790553451
Name:MILLER, JOHN ALLEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 W EMERALD AVE UNIT 299
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-3340
Mailing Address - Country:US
Mailing Address - Phone:480-327-8317
Mailing Address - Fax:
Practice Address - Street 1:60 S 58TH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1507
Practice Address - Country:US
Practice Address - Phone:480-832-3903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist