Provider Demographics
NPI:1285055061
Name:MILLER, EMILIA CARIN (PT)
Entity type:Individual
Prefix:
First Name:EMILIA
Middle Name:CARIN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMILIA
Other - Middle Name:CARIN
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4808 S RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2080
Mailing Address - Country:US
Mailing Address - Phone:248-330-5627
Mailing Address - Fax:
Practice Address - Street 1:6018 W MAPLE RD
Practice Address - Street 2:SUITE 850
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4404
Practice Address - Country:US
Practice Address - Phone:248-932-0111
Practice Address - Fax:248-932-0110
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist