Healthcare Provider Details

I. General information

NPI: 1558014936
Provider Name (Legal Business Name): SCOTT RICHARD MILLER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

740 WESTWOOD TRCE
WOODLAND PARK CO
80863-1282
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-6818
  • Fax:
Mailing address:
  • Phone: 864-979-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0016544
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: