Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 0857 | OH |
NPI | 1003139858 |
---|---|
Provider Name | Celynn Carol Miller |
First Address | Versailles, OH 45380-1323 |
Second Address | Phoenix, AZ 85021-7967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2010 |
Last Update Date | 09/03/2010 |