Provider Demographics
NPI:1891883567
Name:MILLER, MICHELLE MARIE (PHSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:12027 MARBLEHEAD CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8973
Mailing Address - Country:US
Mailing Address - Phone:317-823-8203
Mailing Address - Fax:317-823-8087
Practice Address - Street 1:12027 MARBLEHEAD CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-8973
Practice Address - Country:US
Practice Address - Phone:317-823-8203
Practice Address - Fax:317-823-8087
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001939A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist