Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 854 | WI |
NPI | 1013420942 |
---|---|
Provider Name | Jodi J Miller |
First Address | Brown Deer, WI 53223-3607 |
Second Address | Brown Deer, WI 53223-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2017 |
Last Update Date | 14/11/2017 |