Provider Demographics
NPI:1801952353
Name:MILLER, AMY CHRISTINE (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 MARTINDALE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6714
Mailing Address - Country:US
Mailing Address - Phone:802-318-7323
Mailing Address - Fax:
Practice Address - Street 1:32 MALLETTS BAY AVE
Practice Address - Street 2:AQUATIC REHABILITATION
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1959
Practice Address - Country:US
Practice Address - Phone:802-847-0080
Practice Address - Fax:802-847-0310
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist