Provider Demographics
NPI:1881843761
Name:MILLER, EMILY FENNELL (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:FENNELL
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:FENNELL
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:11006 VEIRS MILL RD
Mailing Address - Street 2:#L15-282
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2582
Mailing Address - Country:US
Mailing Address - Phone:301-933-7827
Mailing Address - Fax:
Practice Address - Street 1:161 JENNIFER RD STE A
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3367
Practice Address - Country:US
Practice Address - Phone:443-481-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205660225100000X
DCPT870914225100000X
MD23167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist