Provider Demographics
NPI:1912069980
Name:MILLER, KRISTI D (PT)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:D
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 1:1296 RAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-1721
Mailing Address - Country:US
Mailing Address - Phone:256-835-6914
Mailing Address - Fax:
Practice Address - Street 1:409 E 10TH ST STE 305
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4781
Practice Address - Country:US
Practice Address - Phone:256-238-0110
Practice Address - Fax:256-238-5143
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3912174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH3912OtherPT LICENSE