Provider Demographics
NPI:1992150957
Name:MILLER, ALISSA MARIE (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17661 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-9775
Mailing Address - Country:US
Mailing Address - Phone:814-573-9933
Mailing Address - Fax:
Practice Address - Street 1:321 ARCH ST STE 101
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3214
Practice Address - Country:US
Practice Address - Phone:814-333-7109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PART006791OtherSTATE BOARD OF MEDICINE