Provider Demographics
NPI:1740619717
Name:MILLER, STACY LYNN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY VIEW
Mailing Address - State:PA
Mailing Address - Zip Code:17983-9738
Mailing Address - Country:US
Mailing Address - Phone:717-202-5724
Mailing Address - Fax:
Practice Address - Street 1:44 DONALDSON RD
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:PA
Practice Address - Zip Code:17981-1424
Practice Address - Country:US
Practice Address - Phone:570-695-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010851L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist