Provider Demographics
NPI:1912230525
Name:MILLER, HEATHER ANN MEFFLEY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANN MEFFLEY
Last Name:MILLER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 N SAMSON WAY
Mailing Address - Street 2:UNIT 3D
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60087-5062
Mailing Address - Country:US
Mailing Address - Phone:513-289-1505
Mailing Address - Fax:
Practice Address - Street 1:660 N WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1659
Practice Address - Country:US
Practice Address - Phone:847-535-8060
Practice Address - Fax:847-535-7834
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.016880225100000X
OH009740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist