Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PTL.0011631 | CO |
Y | 2251N0400X | Physical Therapist - Neurology | 5560 | OK |
NPI | 1063697910 |
---|---|
Provider Name | Bobbette Jean Miller |
First Address | Oklahoma City, OK 73104-4602 |
Second Address | Oklahoma City, OK 73104-4602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2008 |
Last Update Date | 16/01/2019 |