Provider Demographics
NPI:1891092680
Name:MILLER, SUSAN K (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:626 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-3012
Mailing Address - Country:US
Mailing Address - Phone:662-295-6973
Mailing Address - Fax:662-494-2006
Practice Address - Street 1:804 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-3137
Practice Address - Country:US
Practice Address - Phone:662-295-6973
Practice Address - Fax:662-494-2006
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA2962225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPTA2962OtherMISSISSIPPI STATE BOARD OF PHYSICAL THERAPY