Provider Demographics
NPI:1669527024
Name:MILLER, JAMIE R (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:R
Other - Last Name:HARTZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4715 N 32ND ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3300
Mailing Address - Country:US
Mailing Address - Phone:480-689-5520
Mailing Address - Fax:480-706-7409
Practice Address - Street 1:7707 W DEER VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2101
Practice Address - Country:US
Practice Address - Phone:623-376-9100
Practice Address - Fax:623-376-9141
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7320225100000X
2251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5550830010OtherMEDICARE NSC GILBERT
AZ5550830001OtherMEDICARE NSC SCW
AZ5550830007OtherMEDICARE NSC DV
AZ5550830006OtherMEDICARE NSC ANTHEM
AZ102176Medicare PIN
AZ131025Medicare PIN
AZ5550830009OtherMEDICARE NSC AZ NORTH
AZ5550830004OtherMEDICARE NSC PV
AZ5550830008OtherMEDICARE NSC SWV
AZ5550830003OtherMEDICARE NSC PEORIA