Provider Demographics
NPI:1669585733
Name:MILLER, DUSTIN S (PT)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20367 E STONECREST DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6302
Mailing Address - Country:US
Mailing Address - Phone:480-677-3605
Mailing Address - Fax:480-802-8739
Practice Address - Street 1:950 E RIGGS RD
Practice Address - Street 2:STE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5399
Practice Address - Country:US
Practice Address - Phone:480-802-8730
Practice Address - Fax:480-802-8739
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist