Provider Demographics
NPI:1275982993
Name:MILLER, KATIE (PTA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:L
Other - Last Name:SCHALNUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:HILLROSE
Mailing Address - State:CO
Mailing Address - Zip Code:80733-0074
Mailing Address - Country:US
Mailing Address - Phone:970-846-9814
Mailing Address - Fax:
Practice Address - Street 1:2200 EDISON ST
Practice Address - Street 2:
Practice Address - City:BRUSH
Practice Address - State:CO
Practice Address - Zip Code:80723-1609
Practice Address - Country:US
Practice Address - Phone:970-842-2825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0013776225200000X
MTPTP-PTA-LIC-10565225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant