Provider Demographics
NPI:1851393037
Name:MILLER, MICHAEL WAYNE (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 N KIRKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-9239
Mailing Address - Country:US
Mailing Address - Phone:480-227-1240
Mailing Address - Fax:623-934-3887
Practice Address - Street 1:950 E RIGGS RD
Practice Address - Street 2:STE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5399
Practice Address - Country:US
Practice Address - Phone:480-802-0730
Practice Address - Fax:480-802-8739
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7725454OtherAETNA
AZAZ0401980OtherBLUE CROSS BLUE SHIELD
AZ80302Medicare ID - Type Unspecified