Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 0003251 | CO |
N | 2251X0800X | Physical Therapist - Orthopedic | 0003251 | CO |
NPI | 1073072419 |
---|---|
Provider Name | Kristen S Miller |
First Address | Wilsonville, OR 97070-9697 |
Second Address | Grand Junction, CO 81506-5263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2019 |
Last Update Date | 15/03/2019 |