Provider Demographics
NPI:1972277523
Name:MILLER, SAMANTHA (DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 14TH ST W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-6020
Mailing Address - Country:US
Mailing Address - Phone:701-651-6437
Mailing Address - Fax:701-516-8462
Practice Address - Street 1:1905 14TH ST W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-6020
Practice Address - Country:US
Practice Address - Phone:701-651-6437
Practice Address - Fax:701-516-8462
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist