Provider Demographics
NPI:1851349526
Name:MILLER, LEE ELLIOTT (PT, OCS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ELLIOTT
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E ROLLING XRDS STE 57
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6212
Mailing Address - Country:US
Mailing Address - Phone:443-860-9168
Mailing Address - Fax:443-636-5987
Practice Address - Street 1:20 CROSSROADS DR STE 13
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5479
Practice Address - Country:US
Practice Address - Phone:410-363-0015
Practice Address - Fax:410-356-7763
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLV17OtherCAREFIRST BLUECROSS/SHIEL
MD373628800Medicaid
MDE705-0001OtherFEDERAL BLUECROSS/SHIELD
MDE705-0001OtherFEDERAL BLUECROSS/SHIELD