Provider Demographics
NPI:1972511053
Name:MILLER, DENNIS ALAN (ATC/PT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ALAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:ATC/PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 RIDGEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:W LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-5276
Mailing Address - Country:US
Mailing Address - Phone:765-494-3245
Mailing Address - Fax:765-494-9899
Practice Address - Street 1:900 N UNIVERSITY ST # B-63
Practice Address - Street 2:PURDUE UNIVERSITY
Practice Address - City:W LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2070
Practice Address - Country:US
Practice Address - Phone:765-494-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000723A225100000X
IN36000087A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer