Provider Demographics
NPI:1508378910
Name:MILLER, ANITA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13942 STATE HIGHWAY 31 E
Mailing Address - Street 2:
Mailing Address - City:BROWNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75756-6741
Mailing Address - Country:US
Mailing Address - Phone:903-852-8039
Mailing Address - Fax:
Practice Address - Street 1:13942 STATE HIGHWAY 31 E
Practice Address - Street 2:
Practice Address - City:BROWNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75756-6741
Practice Address - Country:US
Practice Address - Phone:903-852-8039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT68142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer