Provider Demographics
NPI:1316999501
Name:MILLER, ANGELA LYNN (ATC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 17TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3798
Mailing Address - Country:US
Mailing Address - Phone:320-762-1511
Mailing Address - Fax:320-762-6471
Practice Address - Street 1:111 17TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3798
Practice Address - Country:US
Practice Address - Phone:320-762-1511
Practice Address - Fax:320-762-6471
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0018612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer