Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1346807260 |
---|---|
Provider Name | John Donald Miller JR. |
First Address | Alexandria, LA 71301-2763 |
Second Address | Pineville, LA 71360-4283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2019 |
Last Update Date | 27/05/2019 |