Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 7311 | SC |
NPI | 1003233792 |
---|---|
Provider Name | Stephen Craig Miller |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Greenville, SC 29605-4265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2014 |
Last Update Date | 09/11/2015 |