Provider Demographics
NPI:1639928112
Name:MILLER, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MOUNTAIN SPRING CT
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05494-9666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 MOUNTAIN SPRING CT
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:VT
Practice Address - Zip Code:05494-9666
Practice Address - Country:US
Practice Address - Phone:802-922-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.00000572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer