Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | AZ5141 | AZ |
N | 2251G0304X | Physical Therapist - Geriatrics | AZ5141 | AZ |
N | 2251S0007X | Physical Therapist - Sports | AZ5141 | AZ |
N | 2251X0800X | Physical Therapist - Orthopedic | AZ5141 | AZ |
NPI | 1447216726 |
---|---|
Provider Name | Scott Allen Milius |
First Address | Phoenix, AZ 85040-3408 |
Second Address | Phoenix, AZ 85040-3408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 25/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S90487 | (02) | AZ |