Provider Demographics
NPI:1649287467
Name:MILLER, SANDRA AL
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:AL
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 VALLEY GATE RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-5366
Mailing Address - Country:US
Mailing Address - Phone:805-526-1465
Mailing Address - Fax:805-497-3416
Practice Address - Street 1:375 ROLLING OAKS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1023
Practice Address - Country:US
Practice Address - Phone:805-497-9481
Practice Address - Fax:805-497-3416
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT009573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist