Healthcare Provider Details

I. General information

NPI: 1548785124
Provider Name (Legal Business Name): THOMS DANIEL MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HENDERSON ST
ARKADELPHIA AR
71999-0001
US

IV. Provider business mailing address

352 S VINE ST
WEST UNION IA
52175-1437
US

V. Phone/Fax

Practice location:
  • Phone: 870-230-5069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: