Provider Demographics
NPI:1457578858
Name:MUIRPT, MILLARD RAY (PT)
Entity Type:Individual
Prefix:MR
First Name:MILLARD
Middle Name:RAY
Last Name:MUIRPT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 N AMELIA ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2404
Mailing Address - Country:US
Mailing Address - Phone:714-779-3866
Mailing Address - Fax:
Practice Address - Street 1:1212 N AMELIA ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2404
Practice Address - Country:US
Practice Address - Phone:714-779-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist