Provider Demographics
NPI:1841696705
Name:MILLER, MISTY M (PT)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:M
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 1:1400 S COULTER ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1786
Mailing Address - Country:US
Mailing Address - Phone:806-414-9680
Mailing Address - Fax:806-354-5591
Practice Address - Street 1:1400 S COULTER ST
Practice Address - Street 2:ROOM 4305
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-414-9684
Practice Address - Fax:806-354-5591
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200571960 AMedicaid
TX345439901Medicaid
TX345439902Medicaid
NM79250572Medicaid
TX403069ZNHDMedicare PIN