Provider Demographics
NPI:1801216841
Name:MILLER, MATTHEW CAMERON (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CAMERON
Last Name:MILLER
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 WATERFORD LAKES DR
Mailing Address - Street 2:APT 3036
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7414
Mailing Address - Country:US
Mailing Address - Phone:727-278-9971
Mailing Address - Fax:
Practice Address - Street 1:7715 WATERFORD LAKES DR
Practice Address - Street 2:APT 3036
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-7414
Practice Address - Country:US
Practice Address - Phone:727-278-9971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer