Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT009414 | GA |
N | 225100000X | Physical Therapist | PT29814 | CA |
NPI | 1003033697 |
---|---|
Provider Name | Jessica Beth Miller |
First Address | Atlanta, GA 30339-3035 |
Second Address | Johns Creek, GA 30097-1828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 03/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00785965 | RR MEDICARE (01) | GA |