Provider Demographics
NPI:1821056946
Name:MILLER, TERESA D (PT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8146 GREENBACK LN
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2551
Mailing Address - Country:US
Mailing Address - Phone:402-676-1702
Mailing Address - Fax:
Practice Address - Street 1:8146 GREENBACK LN
Practice Address - Street 2:SUITE 103A
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2551
Practice Address - Country:US
Practice Address - Phone:402-676-1702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065477701Medicaid