Provider Demographics
NPI:1306174495
Name:MILLER, KATIE AILEEN (LPTA)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:AILEEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26362 NE 1700TH RD
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-9649
Mailing Address - Country:US
Mailing Address - Phone:417-825-0060
Mailing Address - Fax:
Practice Address - Street 1:600 E GARFIELD ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-2034
Practice Address - Country:US
Practice Address - Phone:620-365-3183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02021225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant