Provider Demographics
NPI:1124812136
Name:MILLER, NIKOLAS KYLE (CMT, CPT)
Entity type:Individual
Prefix:
First Name:NIKOLAS
Middle Name:KYLE
Last Name:MILLER
Suffix:
Gender:M
Credentials:CMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E RIVERSIDE DR APT 301
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7482
Mailing Address - Country:US
Mailing Address - Phone:909-721-8554
Mailing Address - Fax:
Practice Address - Street 1:2800 E RIVERSIDE DR APT 301
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7482
Practice Address - Country:US
Practice Address - Phone:909-721-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98669225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty