Healthcare Provider Details

I. General information

NPI: 1902425762
Provider Name (Legal Business Name): SANDRA ANNETTA MILLER PT, CIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 E NICHOLS AVE STE 104
CENTENNIAL CO
80112-3429
US

IV. Provider business mailing address

12074 W 85TH AVE
ARVADA CO
80005-1164
US

V. Phone/Fax

Practice location:
  • Phone: 844-274-6849
  • Fax:
Mailing address:
  • Phone: 303-507-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0003353
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: