Provider Demographics
NPI:1740242858
Name:MILLER, MARCIA LOU (MS PT CHT)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:LOU
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS PT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:156 STRAWBERRY PLAINS RD STE B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-3409
Practice Address - Country:US
Practice Address - Phone:757-565-3400
Practice Address - Fax:757-565-6445
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8928631Medicaid
VA192939OtherBCBS PHYSICAL THERAPY
VA650016244OtherRAILROAD MEDICARE
5366634OtherAETNA
VA650016244OtherRAILROAD MEDICARE
VA650000205Medicare PIN