Provider Demographics
NPI:1154705945
Name:MILLER, KATHRYN NICOLE (PT, DPT, MBA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT, DPT, MBA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:NICOLE
Other - Last Name:RAINVILLE, LEBLANC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5660 W CORTARO FARMS RD STE 108
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-9800
Practice Address - Country:US
Practice Address - Phone:520-462-6167
Practice Address - Fax:602-795-8447
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013367225100000X
AZ012338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist