Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 001003 | WV |
N | 225200000X | Physical Therapy Assistant | 2306601557 | VA |
NPI | 1013034107 |
---|---|
Provider Name | Mrs. Corry Lynn Miller |
First Address | Harpers Ferry, WV 25425-3124 |
Second Address | Charles Town, WV 25414-1170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |