Healthcare Provider Details

I. General information

NPI: 1194842617
Provider Name (Legal Business Name): ALISHA MARIE MILLER MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISHA MARIE ANDERSON MPT

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 N STATE ST
GREENFIELD IN
46140-1066
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 317-467-5700
  • Fax: 317-467-5701
Mailing address:
  • Phone: 630-575-1980
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05008304A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: