Provider Demographics
NPI:1427317197
Name:MILLER, MARK ANTHONY (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 WEST MAIN
Mailing Address - Street 2:PO BOX 1200
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812-1200
Mailing Address - Country:US
Mailing Address - Phone:509-689-2260
Mailing Address - Fax:509-689-8401
Practice Address - Street 1:537 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812-1200
Practice Address - Country:US
Practice Address - Phone:509-689-2260
Practice Address - Fax:509-689-8401
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist