Provider Demographics
NPI:1790766780
Name:MILLER, SCOTT NELSON (MS,PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:NELSON
Last Name:MILLER
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BOUCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2823
Mailing Address - Country:US
Mailing Address - Phone:207-729-3299
Mailing Address - Fax:
Practice Address - Street 1:44 BOUCHARD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2823
Practice Address - Country:US
Practice Address - Phone:207-729-3299
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT20252251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic