Provider Demographics
NPI:1891760245
Name:MILLER, WILVAN M (PT)
Entity Type:Individual
Prefix:
First Name:WILVAN
Middle Name:M
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 1:3912 PARLIAMENT DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3015
Mailing Address - Country:US
Mailing Address - Phone:318-487-0211
Mailing Address - Fax:318-445-6697
Practice Address - Street 1:3912 PARLIAMENT DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3015
Practice Address - Country:US
Practice Address - Phone:318-487-0211
Practice Address - Fax:318-445-6697
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAC3525OtherBC/BS-LA INDIV PROV #
LA6400015OtherUNITED HEALTHCARE
LAC3525OtherBC/BS-LA INDIV PROV #