Provider Demographics
NPI:1245349406
Name:MILLER, KATHRYN E (MSPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:DELANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:563 GOFF RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2425
Mailing Address - Country:US
Mailing Address - Phone:860-678-8655
Mailing Address - Fax:
Practice Address - Street 1:34 DALE RD
Practice Address - Street 2:STE 203
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3659
Practice Address - Country:US
Practice Address - Phone:860-678-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT007433OtherLICENSE #