Provider Demographics
NPI:1790935542
Name:MCVAY, MILLER
Entity Type:Individual
Prefix:
First Name:MILLER
Middle Name:
Last Name:MCVAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 RICHARDSON DR
Mailing Address - Street 2:210
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4659
Mailing Address - Country:US
Mailing Address - Phone:469-941-4603
Mailing Address - Fax:469-930-0179
Practice Address - Street 1:1475 RICHARDSON DR
Practice Address - Street 2:210
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4659
Practice Address - Country:US
Practice Address - Phone:469-941-4603
Practice Address - Fax:469-930-0179
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist