Healthcare Provider Details

I. General information

NPI: 1245898857
Provider Name (Legal Business Name): CATHERINE MILLER DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

IV. Provider business mailing address

2619 RUTLAND RD
NAPERVILLE IL
60564-4745
US

V. Phone/Fax

Practice location:
  • Phone: 630-575-6200
  • Fax:
Mailing address:
  • Phone: 630-818-7299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number2016030518
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number096004449
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: