Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4329 | MN |
NPI | 1003268988 |
---|---|
Provider Name | Timothy Jordan Miller |
First Address | Edina, MN 55435-2104 |
Second Address | Edina, MN 55435-2104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2016 |
Last Update Date | 05/07/2016 |