Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | AK | |
N | 225700000X | Massage Therapist | 1220 | AK |
N | 226300000X | Kinesiotherapist | AK |
NPI | 1699969436 |
---|---|
Provider Name | Mr. Gregg Mathew Miller |
First Address | Wasilla, AK 99654-7892 |
Second Address | Wasilla, AK 99654-7892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 05/09/2007 |