Healthcare Provider Details

I. General information

NPI: 1598684060
Provider Name (Legal Business Name): ALEXIS MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 BROADWAY
HIGHLAND IL
62249-1918
US

IV. Provider business mailing address

6800 STATE ROUTE 162
MARYVILLE IL
62062-8500
US

V. Phone/Fax

Practice location:
  • Phone: 618-651-0022
  • Fax:
Mailing address:
  • Phone: 618-635-2200
  • Fax: 618-635-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160010498
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: