Provider Demographics
NPI:1972968980
Name:MILLER, MONICA (PTA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 INDUSTRY WAY
Mailing Address - Street 2:STE 4
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-4316
Mailing Address - Country:US
Mailing Address - Phone:907-677-9653
Mailing Address - Fax:907-677-9657
Practice Address - Street 1:12201 INDUSTRY WAY
Practice Address - Street 2:STE 4
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4316
Practice Address - Country:US
Practice Address - Phone:907-677-9653
Practice Address - Fax:907-677-9657
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK115397225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant