Provider Demographics
NPI:1972807287
Name:MILLER, ELIZABETH ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2555 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3704
Mailing Address - Country:US
Mailing Address - Phone:619-564-7120
Mailing Address - Fax:619-564-7121
Practice Address - Street 1:2555 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3704
Practice Address - Country:US
Practice Address - Phone:619-564-7120
Practice Address - Fax:619-564-7121
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD234972251S0007X, 2251X0800X
CA395432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports