Provider Demographics
NPI:1902250657
Name:MILLER, ABBY MARIE (MPA ATC LAT)
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MPA ATC LAT
Other - Prefix:MISS
Other - First Name:ABBY
Other - Middle Name:MARIE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC LAT
Mailing Address - Street 1:5401 SE 27TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-2756
Mailing Address - Country:US
Mailing Address - Phone:641-521-2060
Mailing Address - Fax:
Practice Address - Street 1:1709 N JEFFERSON WAY STE 100
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-1459
Practice Address - Country:US
Practice Address - Phone:515-962-9272
Practice Address - Fax:515-962-9282
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0009042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer