Provider Demographics
NPI:1114016540
Name:MILLER, TIMOTHY CLARENCE (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CLARENCE
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 STATE ST STE 10
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4962
Mailing Address - Country:US
Mailing Address - Phone:812-945-4500
Mailing Address - Fax:812-945-4808
Practice Address - Street 1:2441 STATE ST STE 10
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4962
Practice Address - Country:US
Practice Address - Phone:812-945-4500
Practice Address - Fax:812-945-4808
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005346A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist