Provider Demographics
NPI:1427306927
Name:MILLER, PHILLIP DWAYNE II (DPT)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DWAYNE
Last Name:MILLER
Suffix:II
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G2037 S CENTER RD
Mailing Address - Street 2:STE. A
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1173
Mailing Address - Country:US
Mailing Address - Phone:810-743-7950
Mailing Address - Fax:810-743-7951
Practice Address - Street 1:G2037 S CENTER RD
Practice Address - Street 2:STE. A
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519-1173
Practice Address - Country:US
Practice Address - Phone:810-743-7950
Practice Address - Fax:810-743-7951
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist