Provider Demographics
NPI:1134956519
Name:MILLER, BERKLEY
Entity type:Individual
Prefix:
First Name:BERKLEY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5524
Mailing Address - Country:US
Mailing Address - Phone:405-624-0999
Mailing Address - Fax:405-338-9180
Practice Address - Street 1:120 N PERKINS RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5524
Practice Address - Country:US
Practice Address - Phone:405-624-0999
Practice Address - Fax:405-338-9180
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK133051225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant